Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Dec 8;16(1):455.
doi: 10.1186/s13256-022-03659-2.

Topical glucocorticoid application causing iatrogenic Cushing's syndrome followed by secondary adrenal insufficiency in infants: two case reports

Nicola Matejek  1 , Johannes Hoos  2 , Paul Martin Holterhus  3 , Markus Bettendorf  2 , Daniela Choukair  4
Affiliations
Case Reports

Topical glucocorticoid application causing iatrogenic Cushing's syndrome followed by secondary adrenal insufficiency in infants: two case reports

Nicola Matejek et al. J Med Case Rep. .

Abstract

Background: Iatrogenic Cushing's syndrome induced by oral and parenteral glucocorticoid administration is a well-known complication. Immediate withdrawal from exogenous steroids can lead to life-threatening adrenal insufficiency. However, Cushing's syndrome caused by topical treatment with glucocorticoids, such as dexamethasone eye drops or dermal application, is rarely recognized. Young infants in particular are at high risk of suffering from iatrogenic Cushing's syndrome when treated with highly potent topical glucocorticoids.

Case presentation: We present a 6-month-old Syrian boy with cushingoid face after dermal clobetasol cream treatment and a 2-year-old Iranian girl with severe growth retardation after application of dexamethasone eye drops. Both families have a migration background and language barriers. In both cases no endogenous cortisol secretion was initially detected in serum and in 24-hour collected urine. After dose reduction of glucocorticoids, severity of symptoms was reversible and serum cortisol was detectable.

Discussion and conclusion: Young infants are at high risk of developing Cushing's syndrome from topically applied highly potent glucocorticoids. Precise recommendations of treatment dosage, duration, and frequency must be given to the parents, and if necessary, with the help of an interpreter. Monitoring of height and weight as well as regular pediatric follow-ups should be scheduled. Physicians should be aware of potential adrenal insufficiency following withdrawal from long-term topical glucocorticoid treatment, and hydrocortisone treatment should be considered.

Keywords: Dexamethasone eye drops; Iatrogenic Cushing’s disease; Topical application of clobetasol; Topical glucocorticoid application.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Growth chart of case 2, B height velocity of case 2. German references were used for height, weight, and height velocity [27, 28]
See this image and copyright information in PMC

References

    1. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(1):23–43. doi: 10.1016/S0163-7258(02)00297-8. - DOI - PubMed
    1. Stratakis CA. An update on Cushing syndrome in pediatrics. Ann Endocrinol (Paris) 2018;79(3):125–131. doi: 10.1016/j.ando.2018.03.010. - DOI - PubMed
    1. Husebye ES, Pearce SH, Krone NP, Kämpe O. Adrenal insufficiency. Lancet. 2021;397(10274):613–629. doi: 10.1016/S0140-6736(21)00136-7. - DOI - PubMed
    1. Decani S, Federighi V, Baruzzi E, Sardella A, Lodi G. Iatrogenic Cushing’s syndrome and topical steroid therapy: case series and review of the literature. J Dermatolog Treat. 2014;25(6):495–500. doi: 10.3109/09546634.2012.755252. - DOI - PubMed
    1. Tempark T, Phatarakijnirund V, Chatproedprai S, Watcharasindhu S, Supornsilchai V, Wananukul S. Exogenous Cushing’s syndrome due to topical corticosteroid application: case report and review literature. Endocrine. 2010;38(3):328–334. doi: 10.1007/s12020-010-9393-6. - DOI - PubMed

Publication types