Insalaco Anna, Vandelli Sara, Madeo Simona F, Bruzzi Patrizia, Trevisani Viola, Predieri Barbara, Lucaccioni Laura, Iughetti Lorenzo
Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy.
Department of Medical and Surgical Sciences for Mothers, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy.
Case Rep Pediatr. 2025 Jun 16;2025:6109378. doi: 10.1155/crpe/6109378. eCollection 2025.
Intranasal corticosteroids (INCS) are widely used to treat allergic rhinitis and nasal obstruction. While their safety profile is generally well established, both local and systemic side effects can occur. While it is well-known that a chronic exposure to systemic glucocorticoid treatment could determine Cushing's syndrome (CS) and suppression of the hypothalamic-pituitary-adrenal (HPA) axis, there is less awareness when the administration is topical or intranasal. We report the case of an 8-year-old Caucasian girl who developed Cushingoid features following prolonged INCS treatment-initially with betamethasone and subsequently with mometasone furoate. Endocrine testing revealed undetectable baseline and after stimulation cortisol levels, suggesting a condition of adrenal insufficiency secondary to the prolonged glucocorticoid exogenous administration. Temporary hydrocortisone replacement therapy was required. Even if extremely rare, pediatricians should be aware that high-dose and long-term nasal steroid administration may cause iatrogenic CS, as well as systemic glucocorticoid treatment. Clinical features are characterized by the complications of glucocorticoid excess and by the potential life-threatening complications of adrenal insufficiency. Pediatric follow-up should be scheduled during the prolonged steroid treatment and at discontinuation, with prompt referral to a Pediatric Endocrinologist if signs and symptoms of CS (or adrenal insufficiency) are noticed.
鼻内用糖皮质激素（INCS）被广泛用于治疗过敏性鼻炎和鼻塞。虽然其安全性通常已得到充分证实，但局部和全身副作用仍可能发生。虽然众所周知，长期接受全身性糖皮质激素治疗可能会导致库欣综合征（CS）和下丘脑-垂体-肾上腺（HPA）轴抑制，但当给药为局部或鼻内用药时，人们对此的认识较少。我们报告了一例8岁白种女孩的病例，该女孩在长期接受INCS治疗后出现了库欣样特征——最初使用倍他米松，随后使用糠酸莫米松。内分泌检查显示基线及刺激后皮质醇水平均无法检测到，提示长期外源性糖皮质激素给药继发肾上腺功能不全。需要进行临时氢化可的松替代治疗。即使极为罕见，儿科医生也应意识到，高剂量和长期鼻用类固醇给药可能会导致医源性CS，以及全身性糖皮质激素治疗一样。临床特征表现为糖皮质激素过量的并发症以及肾上腺功能不全可能危及生命的并发症。在长期使用类固醇治疗期间及停药时应安排儿科随访，如果发现CS（或肾上腺功能不全）的体征和症状，应及时转诊至儿科内分泌专家处。
