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Adrenal Suppression in Infants Treated with Topical Ocular Glucocorticoids
Regitze Bangsgaard1, Katharina M Main2, Gøril Boberg-Ans1
1Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet/Glostrup, Copenhagen, Denmark.
Insights
Topical ophthalmic glucocorticoids (GCs) after cataract surgery can cause adrenal suppression in infants. Two-thirds of infants tested during treatment showed suppression, highlighting the need for adrenal function assessment.
Area of Science:
- Ophthalmology
- Pediatrics
- Endocrinology
Background:
- Congenital cataract surgery often requires post-operative topical glucocorticoid (GC) treatment.
- The potential for systemic absorption and subsequent adrenal suppression from ophthalmic GCs in infants is a concern.
Purpose of the Study:
- To determine the incidence of adrenal suppression in infants treated with topical ophthalmic GCs.
- To analyze the relationship between GC dosage and adrenal suppression.
Main Methods:
- A retrospective review of 26 infants under 2 years old who underwent congenital cataract surgery.
- Analysis of corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test results and GC dosage per kilogram body weight.
Main Results:
- Of 15 infants tested while on GC treatment, 10 (67%) exhibited adrenal suppression.
- Higher cumulative GC doses in the 5 days prior to testing were associated with suppressed adrenal function.
- Infants with adrenal suppression required hydrocortisone replacement, with recovery noted over time.
Conclusions:
- A significant proportion of infants treated with topical ophthalmic GCs show adrenal suppression.
- Systematic assessment of adrenal function is recommended for infants receiving comparable GC regimens.
- Further evaluation of different treatment regimens is warranted.
Purpose:
To analyze the incidence of adrenal suppression and the glucocorticoid (GC) dose per kilogram body weight given in infants treated with standard protocol for topical ophthalmic GCs after congenital cataract surgery.
Design:
Retrospective, consecutive case series.
Participants:
All children younger than 2 years of age who underwent operation for congenital cataract between January 2011 and May 2015 in 1 center.
Methods:
Patient charts were reviewed to collect data on results and timing of a standard corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test and GC dose per kilogram body weight.
Main Outcome Measures:
Incidence of adrenal suppression in children tested on GC treatment. Glucocorticoid dose per kilogram body weight.
Results:
Among 26 consecutive infants, 15 (58%) were tested while they were still on GC treatment. Ten of these 15 infants (67%) had adrenal suppression, 2 of whom had obvious clinical signs of Cushing's syndrome and 1 of whom had signs of Addisonian crises during general anesthesia. Eleven of the 26 infants (42%) were tested at a median time of 21 days (range, 6-89) after treatment cessation, and they all had normal test results. Children with suppressed adrenal function had received cumulative GC doses per body weight that were significantly higher the last 5 days before testing compared with children with normal test results. Infants with adrenal suppression were treated with hydrocortisone replacement therapy. Adrenal function recovered after a median of 3.1 months (range, 2.3 months to 2.3 years).
Conclusions:
Two thirds of the infants tested during treatment with a standard GC protocol after congenital cataract surgery showed adrenal suppression. There was a significant association between the cumulative daily dose of GCs and the test result. Because adrenal suppression is a serious but treatable condition, we recommend a systematic assessment of adrenal function in infants treated with doses of topical ocular GCs comparable to our regimen and careful evaluations of other treatment regimens.
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