HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in ADC Online Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Perry, R J Articles by Donaldson, M D C Search for Related Content PubMed PubMed Citation Articles by Perry, R J Articles by Donaldson, M D C

Cushing's syndrome, growth impairment, and occult adrenal suppression associated with intranasal steroids

Department of Child Health, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK

Correspondence to:
Correspondence to:
Dr M D C Donaldson, Department of Child Health, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK;
mdcd1t{at}clinmed.gla.ac.uk

ABSTRACT
We have previously described iatrogenic Cushing's syndrome secondary to intranasal steroids. This report further highlights the potential deleterious effects of intranasal steroids.

Nine cases (including the original two cases) are reviewed to show the varied clinical manifestations of adrenal suppression caused by intranasal steroids. Four presented with Cushing's syndrome, three with growth failure, while two asymptomatic patients were discovered in the course of pituitary function testing.

Four children had dysmorphic syndromes—Down's, Treacher–Collins, CHARGE association, and campomelic dysplasia—reflecting the vulnerability of such children to ENT problems, together with the difficulty of interpreting steroid induced growth failure in this context.

Adrenal suppression was seen not only with betamethasone but also with budesonide, beclomethasone and flunisolide nasal preparations.

A careful enquiry as to the use of intranasal steroids should be routine in children presenting with unexplained growth failure or Cushing's syndrome. Particular vigilance/awareness is required in children with dysmorphic syndromes.

Keywords: Cushing's syndrome; intranasal steroid; adrenal suppression; growth failure

Abbreviations: ENT, ear, nose, and throat; HPA, hypothalamopituitary axis

This article has been cited by other articles:

				S. Brochier, O. Alexopoulou, D. Maiter, and M. Buysschaert An Unusual Case of Secondary Diabetes due to Surreptitious Nasal Steroid Use Diabetes Care, June 1, 2005; 28(6): 1535 - 1536. [Full Text] [PDF]