16. Etiology, clinical features and diagnosis of pediatric exogenous Cushing's syndrome
Main Article Content
Abstract
Exogenous Cushing's syndrome is a multisystem disorder caused by long-term use of glucocorticoids (GCs). If not detected early, many serious consequences both physically and psychologically will manifest. In daily clinical practice, we see an increasing number of children with exogenous Cushing's syndrome. Our cohort included 194 children with exogenous Cushing's syndrome diagnosed at the Vietnam National Children's Hospital from February 2022 to February 2023. Our research was a description of case series, retrospective and prospective, to describe the etiology, clinical and laboratory characteristics of children with exogenous Cushing's syndrome. Themedian age at diagnosis was 4.5 years old (3 months old to 18.2 years old). Respiratory tract infection (58.8%) is the most common reason for long term usage of GCs in children. The most common route of administration was per oral (38.1%). The median duration of GCs usage was 4 months, with the longest up to 12 years. The most common symptoms were round face (90.2%) and hirsutism (87.6%). Blood cortisol concentration at 8 a.m. was low (median of 13.4 mmol/L) and ACTH inhibition with serum ACTH level was also low (median of 0.33 pg/ml).
Article Details
Keywords
Exogenous Cushing’s syndrome, glucocorticoids, children
References
2. Chaudhry HS, Singh G. Cushing Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
3. Ahmed SM, Ahmed SF, Othman S, et al. Topical corticosteroid-induced iatrogenic cushing syndrome in an infant; a case report with literature review. Annals of Medicine and Surgery. 2021;71:102978. doi:10.1016/j.amsu. 2021.102978
4. Alkhuder L, Mawlawi H. Infantile Iatrogenic Cushing Syndrome due to Topical Steroids. Case Rep Pediatr. 2019;2019:2652961. Published 2019 Dec 2. doi:10.1155/2019/2652961
5. Ho CWL, Loke KY, Lim YYJ,et al. Exogenous Cushing Syndrome: A Lesson of Diaper Rash Cream. Hormone Research in Paediatrics. 2014;82(6):415-418. doi:10.1159/ 000363517
6. Cushing’s support and Research foundation. Medication Induced Cushing’s. Doctor’s articles. Published on: Jan 21, 2015. https://csrf.net/doctors-articles/med-induced-cushings/medication-induced-cushings/
7. Hopkins RL, Leinung MC. Exogenous Cushing’s syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin North Am. 2005;34(2):371-ix. doi:10.1016/j.ecl.2005.01.0 13
8. Zubillaga I, Francés C, Nicolau J, et al. Adrenal insufficiency and exogenous Cushing’s syndrome in a patient receiving inhaled fluticasone and ritonavir. Endocrinología, Diabetes y Nutrición. doi:10.1016/j.endinu.20 17.02.006
9. De Wachter E, Malfroot A, De Schutter I,et al. Inhaled budesonide induced Cushing’s syndrome in cystic fibrosis patients, due to drug inhibition of cytochrome P450. Journal of Cystic Fibrosis. 2003;2(2):72-75. doi:10.1016/S1569-1993(03)00022-5
10. Celik O, Niyazoglu M, Soylu H, et al. Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs. Multidiscip Respir Med. 2012;7(1):26. Published 2012 Aug 29. doi:10.1186/2049-6958-7-26
11. Savas M, Mehta S, Agrawal N, et al. Approach to the Patient: Diagnosis of Cushing Syndrome. The Journal of Clinical Endocrinology & Metabolism. 2022 Nov;107(11):3162-3174. https://doi.org/10.1210/clinem/dgac492
12. Caniggia A, Nuti R, Lore F, et al. Pathophysiology of the adverse effects of glucoactive corticosteroids on calcium metabolism in man. Journal of Steroid Biochemistry. 1981 Dec;15:153-161. https://doi.org/10.1016/0022-4731(81)90270-3