Cushing's Syndrome in a 6-month-old Boy: A Rare Side-effect due to Inadequate use of Topical Corticosteroids.

SHORT COMMUNICATION Fig. 1. Cushingoid appearance. Typical " moon face " and facial hirsutism at admission (photograph reproduced with parental consent). Topical corticosteroids (TC) are used in several fields of medicine with universally recognized acceptable effectiveness and safety. TC are classified according to their potency, leading to different effectiveness, but also to different local and systemic side-effects. Iatrogenic Cushing's syndrome (CS) and concomitant hypothalamic-pituitary-adrenal (HPA) suppression are potential syste-mic adverse effects caused by the improper use of TC. We report here a case of a 6-month-old boy who developed CS after treatment with a TC prescribed for dermatitis. This case is compared with previously reported cases. An Indian 6-month-old boy was admitted to our hospital with failure to thrive since 2–3 months of age, poor appetite, and growth of hair on the face, neck and shoulders. He was born at term, birth weight 3,240 g (25–50 th percentile). On presentation his body weight was 6,580 g (< 3 rd percen-tile), height 66 cm (3 rd –10 th percentile) and head circumference 43 cm (25–50 th percentile). His heart rate was 118 bpm, blood pressure 104/53 mmHg (above 97 th percentile for age and height), respiratory rate 30/min, and body temperature was normal. Physical examination revealed truncal obesity with a " moon face " appearance, facial and truncal hirsutism (Fig. 1), and erythematous papules in the skin folds of the neck. The patient had a history of neck dermatitis, which had been treated since 2 months of life with a topical combination drug containing fusidic acid 2% and betamethasone valerate 0.1%. The topical steroid was used 2–3 times daily in 7–14-day cycles, despite the fact that it had been prescribed by a community paediatrician for a total of 6 days only. A total of 2 tubes of betamethasone valerate (30 g/tube) had been used within 4 months. Due to language difficulties the parents were unaware of the possible side-effects of the product. Laboratory evaluation revealed a decrease in both morning adrenocorticotropic hormone (ACTH) (7.39 pg/ml; normal 10–60 pg/ml) and cortisol levels (1.17 µg/dl; normal 7–20 µg/ dl). Fasting plasma glucose was 59 mg/dl (normal 60–100 mg/ dl), sodium 140 mEq/l, potassium 5.8 mEq/l, alanine transami-nase 89 UI/l, and aspartate transaminase 76 UI/l. White blood cell count (WBC) was slightly elevated. Other laboratory data, including haemoglobin and platelet count, blood urea nitrogen, creatinine, and bilirubin, were normal. Abdominal ultrasono-graphy was unremarkable. Based …