Iatrogenic Cushing's syndrome in children following nasal steroid

Area of Science:

• Pediatric Endocrinology
• Hormonal Disorders
• Pharmacovigilance

Background:

• Cushing syndrome results from prolonged cortisol exposure.
• Iatrogenic Cushing's syndrome can arise from exogenous steroid use.
• Adenoidal hypertrophy is a common pediatric condition.

Observation:

• Two Nigerian children developed iatrogenic Cushing's syndrome after intranasal aristobed-N (Betamethasone + Neomycin) for adenoidal hypertrophy.
• Clinical and laboratory features of Cushing's syndrome, including critical adrenal suppression, were observed within two months.
• Initial serum cortisol levels were severely low (12 nmol/L and 1.69 nmol/L).

Findings:

• Serum cortisol normalized (343.27 nmol/L) in the first patient three months after discontinuing steroid treatment.
• The second patient showed improving cortisol levels (128 nmol/L) one month into steroid weaning.
• These findings confirm the link between intranasal steroid use and adrenal suppression.

Implications:

• Highlights the potential dangers of unsupervised intranasal steroid administration in children.
• Underscores the importance of vigilant monitoring for Cushing syndrome in pediatric patients using topical steroids.
• Emphasizes the need for healthcare providers to educate caregivers about the risks associated with potent topical corticosteroids.