Different Potent Glucocorticoids, Different Routes of Exposure but The Same Result: Iatrogenic Cushing's syndrome and Adrenal Insufficiency

Objectives: Potent glucocorticoids (GC) cause iatrogenic Cushing Syndrome (ICS) due to suppression of hypothalamo-hypophyseal-adrenal (HPA) axis and later even adrenal insufficiency (AI). The aim of this study is to review the clinical and laboratory findings of patients with ICS and to demonstrate other serious side effects.

Methods: The possibility of AI was investigated by low-dose ACTH test. Hydrocortisone was started in patients with adrenal failure.

Results: Fourteen patients (5 boys) with ages ranging from 0.19 to 11.89 years were included. The duration of GC exposure ranged from 1 to 72 months. Ten patients had been given topical GC, rest of them had oral exposure. One infant used a cream for diaper dermatitis that was claimed to contain panthenol. The infant's blood and urine steroid analyses revealed that all endogenous steroids were suppressed. Moon face and abdominal obesity were detected in all patients. At presentation, 12 of 14 patients had AI and two infants had hypercalcemia and nephrocalcinosis. Of 11 patients, ultrasonography revealed hepatosteatosis in five patients. The HPA axis returned to normal at a median of 60(160) days.

Conclusion: In this series, 85 % of the patients had life-threatening AI and two patients had hypercalcemia. These results pointed out that potent GCs cause serious side effects especially in infants, and the recovery of the HPA axis in children might take as long as 780 days. The parents should be informed regarding the possibility of containing synthetic glucocorticoids in cosmetic products and their side effects.

Keywords: Cushing’s syndrome; adrenal insufficiency; adverse effect; glucocorticoids; hypercalcemia; non-alcoholic fatty liver disease.