Topical corticosteroid-induced iatrogenic cushing syndrome in an infant; a case report with literature review

Diaper dermatitis-a narrative review of clinical presentation, subtypes, and treatment

Diaper dermatitis (DD) is an umbrella term with different clinical presentations, pathophysiology, treatments, and outcomes. The major subtypes include irritant contact dermatitis and candida-associated DD. In case of atypical presentation or unresponsiveness to treatment, other differential diagnoses should be considered. Although DD can occur at any age, it peaks in newborns and infants < 2 years of age. We will focus on this age group in our narrative review.

Betamethasone cream to treat diapers rash causing Cushing syndrome

OBJECTIVES

Betamethasone causing iatrogenic Cushing's syndrome (CS) in infants are rarely reported.

CASE PRESENTATION

In this case report, there were severe signs of CS, such as considerable weight acceleration and concurrent height deceleration, hirsutism and ecchymosis of the face, and buffalo pad, which are often found in adults. Clobetasol propionate, diflucortolone valerate, and dexamethasone nasal sprays were used in the majority of previously reported cases of corticosteroid abuse, whereas this is the first case of CS in an infant as a result of the use of betamethasone cream, also known as betnesol, which is frequently used by mothers in developing countries as a treatment for rashes. In this instance, a severe medication interaction caused by systemic betamethasone cream buildup led to the creation of CS. For the professionals, these patients are a challenge because of drug use without prescription.

CONCLUSIONS

Topical corticosteroid usage puts infants at risk for CS. Because of excessive betamethasone treatment in this child with diaper dermatitis, he acquired CS. It is said to draw attention to the risks of self-medication in developing nations.

Topical Glucocorticoid Use and the Risk of Posttransplant Diabetes

Systemically administered glucocorticoids constitute an essential part of the immunosuppressive regimen for transplant recipients, yet their known risks of causing hyperglycemia or posttransplant diabetes require close monitoring and minimisation of use, when possible, to prevent detrimental effects on patient morbidity and graft survival. Topical glucocorticoids, on the other hand, are rarely considered to affect glucose metabolism and therefore seldomly monitored, despite their wide and in some cases, long-term use. We report a case of a renal transplant recipient presenting with acute hyperosmolar hyperglycemia after treatment with topical glucocorticoids and present a mini review of the literature.

Simultaneous pituitary and adrenal adenomas in a patient with non ACTH dependent Cushing syndrome; a case report with literature review

Introduction

Cushing syndrome is a rare disorder with a variety of underlying etiologies, that can be exogenous or endogenous (adrenocorticotropic hormone (ACTH)-dependent or ACTH-independent). The current study aims to report a case of ACTH-independent Cushing syndrome with adrenal adenoma and nonfunctioning pituitary adenoma.

Case report

A 37–year–old female presented with amenorrhea for the last year, associated with weight gain. She had a moon face, buffalo hump, and central obesity. A 24-hour urine collection for cortisol was performed, revealed elevated cortisol. Cortisol level was non-suppressed after administering dexamethasone. MRI of the pituitary region revealed a pituitary microadenoma, and the CT scan of the abdomen with adrenal protocol revealed a left adrenal adenoma.

Discussion

Early diagnosis may be postponed due to the variety of clinical presentations and the referral of the patient to different subspecialists based on their dominant symptoms (gynecological, dermatological, cardiovascular, psychiatric); it is, therefore, critical to consider the entire clinical presentation for correct diagnosis.

Conclusion

Due to the diversity in the presentation of CS, an accurate clinical, physical and endocrine examination is always recommended.

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Cushing syndrome (CS) is a rare disorder with a variety of underlying etiologies.

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CS is expected to affect 0.2 to 5 people per million per year.

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Adrenal-dependent CS is an uncommon variant of CS.

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This study reports a rare occurrence of pituitary and adrenal adenoma with CS.