Lesson of the week: Childhood Cushing's syndrome induced by betamethasone nose drops, and repeat prescriptions

BMJ 1998;317:739-740 ( 12 September )

Clinical review

Lesson of the week

Childhood Cushing's syndrome induced by betamethasone nose drops, and repeat prescriptions

Children should have betamethasone nose drops prescribed for only short periods

C A Findlay, specialist registrar, ^a J F Macdonald, pharmacy clinical services manager, ^a A M Wallace, principal scientist, ^b N Geddes, consultant ear, nose, and throat surgeon, ^a M D C Donaldson, consultant paediatric endocrinologist. ^a

^a Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, ^b Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow

Correspondence to: Dr Donaldson. Malcolm.d.donaldson@clinmed.gla.ac.uk

The first 150 words of the full text of this article appear below.

Iatrogenic Cushing's syndrome secondary to oral corticosteroid treatment is well documented, as is systemic absorption oftopical steroid preparations that are potent or used for a longtime. However, frank Cushing's syndrome as a result of inhaledor intranasal corticosteroids is not well recognised. We presenttwo cases of childhood Cushing's syndrome secondary to prolongeduse of intranasalbetamethasone.

	Case reports

Case 1
A boy aged 7 years was referred to the endocrine clinic with a history of growth failure associated with obesity. Over thepast two years his weight had increased from the 50th to the 97thcentile with height falling from the 10th to the 3rd centile.He had no history of note apart from mild atopy and chronic catarrh,for which he had been prescribed 0.1% betamethasone nasaldrops.

On examination he was cushingoid with normal prepubertal genitalia. His blood pressure was 165/75 mm Hg (>95th centile forage). Pituitary . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Do you really need betamethasone nose drops in children: Andreas F P Temmel, et al.
bmj.com, 11 Sep 1998 [Full text]
Allergen avoidance measures should be considered in all patients with allergic rhinitis: Aziz Sheikh
bmj.com, 17 Sep 1998 [Full text]
Toxicity of intranasal steroids: C Vidyashankar
bmj.com, 23 Sep 1998 [Full text]
Steroid nasal drops in children: Mark G Watson
bmj.com, 1 Oct 1998 [Full text]
Topical nasal betamethasone suppresses endogenous cortisol production: Jarrod J Homer
bmj.com, 8 Oct 1998 [Full text]
Untitled: Tim Scorrer
bmj.com, 28 Oct 1998 [Full text]
Other intranasal corticosteroids may cause problems: Saul Malozowski
bmj.com, 5 Nov 1998 [Full text]