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Pediatric iatrogenic Cushing’s syndrome: a series of seven cases induced by topical corticosteroid use

  • Fatih Kilci ORCID logo EMAIL logo and Emre Sarıkaya ORCID logo
Published/Copyright: April 28, 2025
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 8

Abstract

Objectives

Cushing’s syndrome (CS) in children is often caused by prolonged glucocorticoid use. Exogenous steroid administration, mainly oral and parenteral, commonly leads to iatrogenic CS, while topical corticosteroids’ role is less recognized. Here, we present seven pediatric cases of iatrogenic CS linked to topical glucocorticoids, resulting in adrenal insufficiency.

Case presentation

There were seven patients, aged 3–60 months, with diaper dermatitis (six patients) and scabies (one patient), all receiving topical clobetasol propionate for a median duration of 2 months (range: 0.5–3 months). Adrenal insufficiency was detected in all cases and treated with hydrocortisone at a median dose of 10 mg/m2/day (range: 7.5–50 mg/m2). One infant also had hypercalcemia. Clinical findings and anthropometric measurements normalized during follow-up, with a median hypothalamic–pituitary–adrenal axis recovery time of 6 months (range: 4–9 months).

Conclusions

This study contributes valuable insights into the management of iatrogenic CS in pediatric patients and emphasizes the need for cautious prescribing practices to safeguard against adverse effects.

Keywords: iatrogenic Cushing; adrenal insufficiency; hypercalcemia; clobetasol propionate; topical corticosteroids
Corresponding author: Fatih Kilci, MD, Department of Pediatric Endocrinology, Kocaeli City Hospital, Kocaeli, Türkiye, E-mail:

Acknowledgments

We thank the parents of the patients described for allowing us to share their details.

  1. Research ethics: The local Institutional Review Board deemed the study exempt from review.

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The datasets used and/or analyzed in the present study are available from the corresponding author on reasonable request.

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Received: 2025-01-14
Accepted: 2025-04-16
Published Online: 2025-04-28
Published in Print: 2025-08-26

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2025-0032
Keywords for this article
iatrogenic Cushing; adrenal insufficiency; hypercalcemia; clobetasol propionate; topical corticosteroids

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Endocrine treatment in Duchenne muscular dystrophy – current practices and future directions
  4. Reviews
  5. Pubertal induction therapy in pediatric patients with Duchenne muscular dystrophy
  6. Evaluating obesity and fat cells as possible important metabolic players in childhood leukemia
  7. Biological effects of recombinant human growth hormone therapy on metabolism in children with growth hormone deficiency: a review
  8. Original Articles
  9. The use of bisphosphonate and testosterone in young people with Duchenne muscular dystrophy: an international clinician survey
  10. Characterizing the metabolome of children with growth hormone deficiency
  11. Is L-dopa test effective in detecting adrenal insufficiency with preliminary diagnosis of growth hormone deficiency in children with short stature?
  12. Comparison of the clinical characteristics of children with Silver–Russell syndrome genetically confirmed or not and their response to growth hormone therapy: a national multicenter study
  13. Testicular adrenal rest tumors in Indonesian boys with congenital adrenal hyperplasia
  14. Oxidative stress in branched-chain organic acidemias using thiol-disulfide homeostasis
  15. Case Reports
  16. Delayed diagnosis of retroperitoneal paraganglioma in an 8-year-old boy with persistent hypertension: a case report and review of diagnostic challenges in pediatric secondary hypertension
  17. Pediatric iatrogenic Cushing’s syndrome: a series of seven cases induced by topical corticosteroid use
  18. Wolcott–Rallison syndrome: late-onset diabetes, multiple epiphyseal dysplasia, and acute liver failure – a case report
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