Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report
Introduction: Iatrogenic Cushing syndrome (ICS) can be caused by synthetic glucocorticoids administered through various routes. ICS caused by corticosteroid eye drops is an exceptional event, being more frequent in pediatric age. Herein, we describe a case of ICS associated with secondary...
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Karger Publishers
2025-02-01
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| Series: | Case Reports in Ophthalmology |
| Online Access: | https://karger.com/article/doi/10.1159/000543908 |
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| author | Joana Santos-Oliveira Luís Torrão Sónia Torres-Costa Marta Silva Ana Catarina Pedrosa Joana Araújo Luís Figueira Cláudia Oliveira-Ferreira |
| author_facet | Joana Santos-Oliveira Luís Torrão Sónia Torres-Costa Marta Silva Ana Catarina Pedrosa Joana Araújo Luís Figueira Cláudia Oliveira-Ferreira |
| author_sort | Joana Santos-Oliveira |
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Introduction: Iatrogenic Cushing syndrome (ICS) can be caused by synthetic glucocorticoids administered through various routes. ICS caused by corticosteroid eye drops is an exceptional event, being more frequent in pediatric age. Herein, we describe a case of ICS associated with secondary adrenal insufficiency (SAI) caused by ocular topical corticosteroid treatment. Case Presentation: An 11-year-old girl was referred to our ocular inflammation department due to idiopathic, chronic, non-hypertensive, non-granulomatous bilateral anterior uveitis, treated with topical dexamethasone (eye drops, 1 mg/mL) for 1 year. During the past year, the child and her mother observed a gradual change in her physical appearance, particularly noting the development of a cushingoid facial appearance. Laboratory data revealed morning serum adrenocorticotropic hormone (ACTH) of 3.6 ng/L (7.2–63.3) and morning serum cortisol of 0.20 µg/dL (6.2–19.4). She was treated with methotrexate (15 mg/week, orally), and the topical corticosteroid regimen was progressively tapered and discontinued after 3 months. Nine months after the patient discontinued corticosteroid eye drops, her cushingoid face disappeared, and her laboratory data improved. Regarding the ophthalmological examination, the uveitis remained in remission with methotrexate, with no new episodes of intraocular inflammation. Conclusion: Although rare, ophthalmologists must be aware of ICS and SAI and prioritize using the least potent corticosteroid for the shortest duration necessary. Additionally, clinicians should avoid abrupt cessation of long-term corticosteroid therapy as this can precipitate an adrenal crisis in the presence of adrenal insufficiency. |
| format | Article |
| id | doaj-art-b1183c8cfe6d40618ada0ea154c45bcc |
| institution | Kabale University |
| issn | 1663-2699 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Karger Publishers |
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| series | Case Reports in Ophthalmology |
| spelling | doaj-art-b1183c8cfe6d40618ada0ea154c45bcc2025-08-20T03:49:41ZengKarger PublishersCase Reports in Ophthalmology1663-26992025-02-0116119420110.1159/000543908Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case ReportJoana Santos-Oliveirahttps://orcid.org/0000-0003-0260-8469Luís Torrãohttps://orcid.org/0000-0003-0555-6860Sónia Torres-Costahttps://orcid.org/0000-0002-7079-9554Marta Silvahttps://orcid.org/0009-0000-5906-6061Ana Catarina Pedrosahttps://orcid.org/0000-0001-6831-5488Joana Araújohttps://orcid.org/0000-0002-6140-096XLuís Figueirahttps://orcid.org/0000-0002-4481-882XCláudia Oliveira-Ferreirahttps://orcid.org/0000-0002-9446-7140 Introduction: Iatrogenic Cushing syndrome (ICS) can be caused by synthetic glucocorticoids administered through various routes. ICS caused by corticosteroid eye drops is an exceptional event, being more frequent in pediatric age. Herein, we describe a case of ICS associated with secondary adrenal insufficiency (SAI) caused by ocular topical corticosteroid treatment. Case Presentation: An 11-year-old girl was referred to our ocular inflammation department due to idiopathic, chronic, non-hypertensive, non-granulomatous bilateral anterior uveitis, treated with topical dexamethasone (eye drops, 1 mg/mL) for 1 year. During the past year, the child and her mother observed a gradual change in her physical appearance, particularly noting the development of a cushingoid facial appearance. Laboratory data revealed morning serum adrenocorticotropic hormone (ACTH) of 3.6 ng/L (7.2–63.3) and morning serum cortisol of 0.20 µg/dL (6.2–19.4). She was treated with methotrexate (15 mg/week, orally), and the topical corticosteroid regimen was progressively tapered and discontinued after 3 months. Nine months after the patient discontinued corticosteroid eye drops, her cushingoid face disappeared, and her laboratory data improved. Regarding the ophthalmological examination, the uveitis remained in remission with methotrexate, with no new episodes of intraocular inflammation. Conclusion: Although rare, ophthalmologists must be aware of ICS and SAI and prioritize using the least potent corticosteroid for the shortest duration necessary. Additionally, clinicians should avoid abrupt cessation of long-term corticosteroid therapy as this can precipitate an adrenal crisis in the presence of adrenal insufficiency.https://karger.com/article/doi/10.1159/000543908 |
| spellingShingle | Joana Santos-Oliveira Luís Torrão Sónia Torres-Costa Marta Silva Ana Catarina Pedrosa Joana Araújo Luís Figueira Cláudia Oliveira-Ferreira Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report Case Reports in Ophthalmology |
| title | Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report |
| title_full | Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report |
| title_fullStr | Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report |
| title_full_unstemmed | Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report |
| title_short | Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency in a Child due to Topical Ocular Corticosteroids: A Case Report |
| title_sort | iatrogenic cushing syndrome and secondary adrenal insufficiency in a child due to topical ocular corticosteroids a case report |
| url | https://karger.com/article/doi/10.1159/000543908 |
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