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Cushing's syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse?

Ayla Güven1, Ozlem Gülümser, Tolga Ozgen

  • 1Department of Pediatric Endocrinology, Ondokuz Mayis University Medical Faculty, Turkey. aylaguven@yahoo.com

Journal of Pediatric Endocrinology & Metabolism : JPEM
|January 11, 2008
PubMed

Insights

Potent topical steroids can suppress the hypothalamic-pituitary-adrenal (HPA) axis in infants, leading to serious side effects like liver issues. Physicians and parents must be aware of these risks and avoid prolonged use.

Area of Science:

  • Pediatric Endocrinology
  • Dermatology
  • Pharmacology

Background:

  • Topical corticosteroids, when applied long-term, can suppress the hypothalamic-pituitary-adrenal (HPA) axis.
  • Infants are at higher risk for Cushing's syndrome or adrenocortical insufficiency due to potent glucocorticoid absorption through the diaper area.
  • This study reports on six infants exposed to potent topical corticosteroids without a prescription.

Observation:

  • Infants aged 3-8 months were exposed to potent topical corticosteroids (clobetasol propionate, diflucortolone valerate).
  • Clinical examinations and laboratory tests were performed to assess HPA axis function and other side effects.
  • Abdominal ultrasonography was used to detect hepatosteatosis.

Findings:

  • All infants showed HPA axis suppression confirmed by ACTH stimulation tests.
  • Hepatomegaly was present in all infants, with hepatosteatosis in three.
  • Elevated liver transaminases were observed in five infants; one infant died from Cytomegalovirus infection.

Implications:

  • Physicians must recognize and manage the dangerous side effects of potent topical steroids in infants.
  • Long-term use of potent topical corticosteroids in infants should be avoided.
  • Informed consent regarding potential side effects is crucial when prescribing topical steroids for infants.
Abstract

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