ESPE Abstracts

Introduction: Cushing's syndrome is a rare but serious condition in children. It is most often of iatrogenic origin, resulting from the prolonged use of glucocorticoids. It is responsible for increased cardiovascular mortality, highlighting the importance of recognizing and treating it. Cushing's syndrome due to topical application is a very rare cause, with only a few cases reported in the literature. We present here three cases of iatrogenic Cushing's syndrome resulting from the application of a very potent dermocorticoid.

Observation: We received, over a period of one month, three female infants referred for the management of Cushing's syndrome. The average age was 7.5 months, the average duration of symptoms was 1.5 months, and the clinical presentation was characterized by obesity, a deviation from the growth curve, and cutaneous signs of hypercorticism. The history, along with the biological and morphological investigations, supported a diagnosis of iatrogenic Cushing's syndrome due to class IV dermocorticoids. Dermocorticoids were prescribed in one case and self-medicated in two cases. Regarding complications, we noted urinary infection in two patients, dyslipidemia, and arterial hypertension in one case. The three infants were treated with hydrocortisone at a dose of 15 mg/kg/day, divided into two doses, and dermocorticoids were discontinued. Progress to date has been positive, with regression of clinical signs in all three patients.

Discussion: Similar to various orally administered glucocorticoids, dermocorticoids have anti-inflammatory potency equal to or greater than cortisol, with a varying potential risk of inducing iatrogenic Cushing's syndrome, particularly in the pediatric population. Hence, potent dermocorticoids should be avoided in children.