Introduction: Topical corticosteroids are often used for the treatment of dermatological diseases. However, systemic adrenal insufficiency may result from their overuse. Patients at risk for development of adrenal insufficiency include especially young children and patients with damaged skin barriers.
Case presentation: We report the case of a 11-year-old boy who was seen in our clinic for suspicion of Cushing syndrome. He was adressed by a dermatologist who treated his dishydrotic eczema of the hands with 0.05% betametason cream during three years. He used the cream only during exacerbations (twice a day on the hands during 1 week). The physical examination revealed an obesity, a weight of 79 kg height of 157 cm, (BMI 32.3 kg/m2), His sitting blood pressure was 121/60 mm Hg. Laboratory data revealed fasting blood glucose 98 mg/dl, plasma sodium 140 mEq/l, plasma potassium 4.3 mEq/l, hemoglobin 14.4 g/dl, free T4 1.11 ng/dl (0.81.7), TSH 1.2 mU/l [0.74.65]. Basal serum cortisol levels (at 0800 h) were <1 μg/dl (3.719.4) and basal ACTH was 1.3 ng/l (7.263.3). Twenty four hours urinary cortisol was <16 μg/24 h (16176). Topical corticosteroid was stopped and hydrocortison at physiological doses (10 mg/m2 per day) was started as well as recommendations in case of fever or disease. Four months later, a 250 μg cosyntropin stimulation test (Synacthen) was performed. Cortisol levels were 241 ng/ml , ACTH was 77.3 pg/ml [7.2-63.3], DHEAS 139 μg/dl , 17 OH-progesterone 4.5 nmol/l [2.710]. The HPA axis was no longer suppressed. Hydrocortison was stopped. Five months later, twenty four hours urinary cortisol was performed: 45 μg/24hours (16176). Physical examination showed a weight of 86 kg, a height of 160 cm, (BMI 33.7 kg/m2), His sitting blood pressure was 119/63 mmHg. The obesity was probably not due to a topical corticosteroid.
Conclusion and teaching points: Among the adverse effects associated with topical corticosteroid use, the most dangerous is HPA axis suppression, which in some cases, can be life threatening.Therefore, it should be used with an increased awareness of the potential risk of adrenal axis suppressive effects.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology