Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter May 22, 2014

Cushing’s syndrome: hidden risk in usage of topical corticosteroids

  • Ayşe Derya Buluş EMAIL logo , Nesibe Andıran and Mesut Koçak

Abstract

Iatrogenic Cushing’s syndrome in children may occur as a result of the application of exogenous steroids. Prolonged use of powerful corticosteroids suppresses adrenal functions and iatrogenic Cushing’s syndrome may develop particularly in infants who are given topical corticosteroids. We report here a case on three infants having Cushing’s syndrome with similar clinical presentations due to overuse of topical steroids for diaper dermatitis. The importance of exercising caution during the use of topical steroids is underlined in this study.


Corresponding author: Ayşe Derya Buluş, MD, Department of Pediatric Endocrinology, Kecioren Training and Research Hospital, Pinarbasi Mahallesi Sanatoryum Caddesi Ardahan sok. no:1 Kecioren 06310, Ankara, Turkey, Phone: +90 312 356 90 00, Fax: +90 312 356 90 22, E-mail:

References

1. Allen DB. Safety of inhaled corticosteroids in children. Pediatr Pulmonol 2002;33:208–20.10.1002/ppul.10040Search in Google Scholar

2. Hengge UR, Ruzicka T, Shwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol 2006;54:1–15.10.1016/j.jaad.2005.01.010Search in Google Scholar

3. Wolkerstorfer A, Visser RL, De Waard van der Spek FB, Mulder PG, Oranje AP. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: influence of corticosteroid dilution. Br J Dermatol 2000;143:999–1004.10.1046/j.1365-2133.2000.03833.xSearch in Google Scholar

4. Şıklar Z, Bostancı I, Atli O, Dallar Y. An infantile Cushing syndrome due to misuse of topical steroid. Pediatr Dermatol 2004;21:561–3.10.1111/j.0736-8046.2004.21508.xSearch in Google Scholar

5. Andıran N. “Diaper Dermatit” ten Cushing Sendromuna. Yeni Tıp Dergisi 2007;24:112–4.Search in Google Scholar

6. Güven A, Gülümser O, Özgen T. Cushing’s syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse? J Pediatr Endocrinol Metab 2007;20:1173–82.10.1515/JPEM.2007.20.11.1173Search in Google Scholar

7. Semiz S, Yasemin BI, Ergin Ş, Candemir M, Polat A. Two cases of Cushing’s syndrome due to overuse of topical steroid in the diaper area. Pediatric Dermatol 2008;5:544–7.10.1111/j.1525-1470.2008.00735.xSearch in Google Scholar

8. Gilbertson EO, Spellman MC, Piacquadio DJ, Mulford MI. Super potent topical corticosteroid use associated with adrenal suppression: clinical considerations. J Am Acad Dermatol 1998;38:318–21.10.1016/S0190-9622(98)70573-0Search in Google Scholar

9. Nield LS, Kamat D. Prevention, diagnosis and management of diaper dermatitis. Clin Pediatr 2007;6:480–6.Search in Google Scholar

10. Boumpas DT, Paliogianni F, Anastassiou ED. Glucocorticosteroid action on the immune system: molecular and cellular aspects. Clin Exp Rheumatol 1991;9:413–23.Search in Google Scholar

11. Boscaro M, Barzon L, Fallo F, Sonino N. Cushing’s syndrome. Lancet 2001;357:783–91.10.1016/S0140-6736(00)04172-6Search in Google Scholar

12. Baş VN, Çetinkaya S, Aycan Z. Iatrogenic Cushing syndrome due to nasal steroid drops. Eur J Pediatr 2012;171:735–6.10.1007/s00431-011-1645-9Search in Google Scholar PubMed

13. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Phys 2009;79:135–40.Search in Google Scholar

14. Tordjman K, Jaffe A, Trostanetsky Y, Greenman Y, Limor R, et al. Low dose (1 μg) adrenocortocotrophin (ACTH) stimulation as a screening test for impaired hypothalamo-pituitary-adrenal axis function: sensitivity, specificity and accuracy in comparison with the high dose (250 μg) test. Clin Endocrinol 2000;52:633–40.10.1046/j.1365-2265.2000.00984.xSearch in Google Scholar PubMed

15. Crowley S, Hindmarsh PC, Honour JW, Brook CGD. Reproducibility of the cortisol response to stimulation with a low dose of ACTH: the effect of basal cortisol levels and comparison of low-dose with high-dose secretory dynamics. J Endocrinol 1993;136:167–72.10.1677/joe.0.1360167Search in Google Scholar PubMed

16. Colao A, Pivanello R. The diagnosis of secondary adrenal insufficiency: low dose vs high dose ACTH stimulation test. J Endocrinol Invest 2003;26:1–2.10.1007/BF03345114Search in Google Scholar PubMed

Received: 2013-7-3
Accepted: 2014-4-1
Published Online: 2014-5-22
Published in Print: 2014-9-20

©2014 by De Gruyter

Downloaded on 7.6.2024 from https://www.degruyter.com/document/doi/10.1515/jpem-2013-0262/html
Scroll to top button