Messina Maria Francesca, Valenzise Mariella, Aversa Salvatore, Arrigo Teresa, De Luca Filippo
University of Messina, Department of Pediatrics, Viale Gazzi 1, Messina, 98124, Italy.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.11.2008.1224. Epub 2009 May 8.
A boy aged 7.6 years presented to our Unit of Paediatric Endocrinology for evaluation of obesity. Progressive weight gain (10 kg) started 6 months earlier after an accidental penetrating orbital injury on the right eye. During this period the child has been treated with oral betamethasone (0.5 mg/day) for 1 month and dexamethasone 2% ocular drops (2 hourly by day) for 6 months. Physical examination showed he was 113.5 cm in height (-1.5 SD), weight 36.0 kg, blood pressure 110/90 mmHg (90th centile), body mass index 28 (+5 SD), truncal obesity, buffalo hump, "moon-face", increased lanugo hair and supraclavicular fullness. Endocrinological work-up revealed undetectable levels of basal adrenocorticotropic hormone (ACTH), basal and ACTH-stimulated cortisol and 24 h urine excretion cortisol, confirming the diagnosis of iatrogenic Cushing syndrome. The abrupt withdrawal of ocular glucocorticoids by the parents evoked two adrenal crises; 4 months later the patient recovered. In conclusion, we would alert doctors that every formulation of glucocorticoids, no ocular drops excluded, can determine severe systemic side effects and iatrogenic Cushing syndrome.
一名7.6岁男孩因肥胖问题前来我们的儿科内分泌科就诊。在右眼意外穿透性眼眶损伤6个月后，体重开始逐渐增加（10千克）。在此期间，该儿童接受了1个月的口服倍他米松（0.5毫克/天）治疗以及6个月的2%地塞米松眼药水（每天每2小时一次）治疗。体格检查显示，他身高113.5厘米（低于标准差1.5），体重36.0千克，血压110/90毫米汞柱（第90百分位），体重指数28（高于标准差5），有躯干肥胖、水牛背、“满月脸”、胎毛增多和锁骨上饱满。内分泌检查显示基础促肾上腺皮质激素（ACTH）、基础及ACTH刺激后的皮质醇水平以及24小时尿皮质醇排泄量均无法检测到，确诊为医源性库欣综合征。家长突然停用眼部糖皮质激素引发了两次肾上腺危象；4个月后患者康复。总之，我们提醒医生，每种糖皮质激素制剂，包括眼药水，都可能导致严重的全身副作用和医源性库欣综合征。
