Sobngwi E, Lubin V, Ury P, Timsit F-J, Gautier J-F, Vexiau P
Department of Endocrinology and Diabetes, St-Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France.
Ann Endocrinol (Paris). 2003 Jun;64(3):202-4.
We report a case of symptomatic topical corticosteroid-induced adrenal insufficiency and diabetes in a 46-yr old HIV 1 positive woman of African descent. Topical Betamethasone dipropionate 0.05%-containing creams were used for the purpose of bleaching over a 2 month period prior to the acute episode. She recovered from her acute onset diabetes with ketosis and adrenal insufficiency a few months after withdrawal of corticosteroids. Despite possible discussion about pathophysiology of diabetes because acute-onset remitting diabetes is not rare in patients of African descent, and diabetes may occur in patients taking anti-retroviral treatments, no other cause of a hypothalamo-pituitary-adrenal axis disorder was found. This case suggests that chronic use of high dose topical corticosteroid containing creams should be ruled out in patients presenting with Hypothalamo-Pituitary-Adrenal hypofunction.
我们报告了一例有症状的局部用皮质类固醇诱发的肾上腺功能不全和糖尿病病例，患者为一名46岁的非洲裔HIV-1阳性女性。在急性发作前的2个月期间，使用了含0.05%二丙酸倍他米松的局部乳膏进行皮肤美白。停用皮质类固醇几个月后，她从急性发作的糖尿病伴酮症和肾上腺功能不全中康复。尽管可能会讨论糖尿病的病理生理学，因为急性发作缓解型糖尿病在非洲裔患者中并不罕见，且糖尿病可能发生在接受抗逆转录病毒治疗的患者中，但未发现下丘脑-垂体-肾上腺轴紊乱的其他原因。该病例表明，对于出现下丘脑-垂体-肾上腺功能减退的患者，应排除长期使用高剂量含皮质类固醇的局部乳膏的情况。
