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Factitious hypertension with mineralocorticoid excess in an infant
Insights
Topical steroid cream misuse in a breastfeeding mother caused severe health issues in her infant, including hypertension and electrolyte imbalances. The infant recovered after discontinuing the steroid exposure.
Area of Science:
- Pediatric Endocrinology
- Dermatology
- Clinical Pharmacology
Background:
- Neonatal and infant health can be significantly impacted by environmental and maternal exposures.
- Prolonged QT interval, hypokalemia, alkalosis, and hypertension in infants warrant thorough etiological investigation.
Observation:
- A 2-month-old infant presented with severe hypokalemia, alkalosis, hypertension (200/100 mm Hg), and hypotonia.
- Endocrinological evaluation revealed suppressed pituitary-adrenal and renin-aldosterone functions.
- Normal imaging studies (CT, cavography, pyelography) excluded structural causes.
Findings:
- The infant's symptoms were attributed to maternal use of a topical corticosteroid cream (1% 9-alpha-fluoroprednisolone-21-acetate) for nipple care.
- Discontinuation of the topical steroid led to gradual normalization of blood pressure and resumption of normal growth.
Implications:
- This case highlights the potential for systemic absorption and adverse effects of topical corticosteroids, even in neonates via breastfeeding.
- Emphasizes the critical need to consider pharmacological causes, including maternal medication use, in infant disease presentation.
- Underscores the risks associated with potent topical steroid use, particularly in vulnerable populations.
Abstract:
A 2-month-old breast-fed baby is described, who, admitted for a prolongation of the QT interval on ECG, was found to be severely hypokalemic, alkalotic and hypertensive (blood pressure 200/100 mm Hg). Marked generalized hypotonia was present, and length was less than 3% for age. The results of endocrinological evaluation showed profound suppression of the pituitary-adrenal function and of the renin-aldosterone mechanism. CT scan, cavography and pyelography were normal. A pharmacological cause for the symptoms was sought and found: the mother had been using for the care of bruised nipples a cream containing 1% 9-alpha-fluoroprednisolone-21-acetate. Blood pressure remained elevated for 6 months, but became normal after one year, and growth has resumed normally. The possible differential diagnoses are considered, and the risks presented by topical steroids are emphasized.