Berun A. Abdalla, Honar O. Kareem, Bilal A. Mohammed, Karzan M. Hasan, Soran M. Ahmed, Khdir Hussein Hamad Khoshnaw, Wirya N. Sabr, Ronak S. Ahmed and 6 more
Introduction Despite the increasing number of pediatric cases of iatrogenic Cushing's syndrome (CS) due to topical corticosteroids, systematic reviews are lacking to provide comprehensive insights into the disease. This study aims to provide a systematic overview of the disease. Methods Relevant literature was…
Cushing's Syndrome and Topical Corticosteroids in Pediatrics: A Systematic Review
Berun A. Abdalla, Honar O. Kareem, Bilal A. Mohammed, Karzan M. Hasan, Soran M. Ahmed, Khdir Hussein Hamad Khoshnaw, Wirya N. Sabr, Ronak S. Ahmed and 6 more
IntroductionDespite the increasing number of pediatric cases of iatrogenic Cushing's syndrome (CS) due to topical corticosteroids, systematic reviews are lacking to provide comprehensive insights into the disease. This study aims to provide a systematic overview of the disease.
MethodsRelevant literature was identified using Google Scholar and PubMed. The search strategy was restricted to studies on human published in English. The inclusion criteria encompassed confirmed pediatric cases of iatrogenic CS induced by topical corticosteroids.
ResultsThe mean age of the cases was 38.8 months, with a female gender predominance (57.1%). Abnormalities in growth patterns were observed in approximately 75% of the cases. The most common clinical presentation was a "moon face" appearance (74.6%), followed by weight gain (55.5%). Clobetasol propionate was the most frequently used topical steroid (54%), followed by betamethasone types (35%). The mean duration of steroid use was 25.4 weeks. The primary indications for steroid use were dermatitis (47.6%), psoriasis (17.5%), and scabies (15.9%). Laboratory tests for adrenocorticotropic hormone and cortisol levels revealed low levels in 73% and 78% of cases, respectively. All cases had their initial steroid discontinued. Oral hydrocortisone was the primary replacement therapy (39.7%), followed by sulfur cream (12.7%). Fifty-one cases (81%) recovered from the disease. Partial recovery was observed in 2 cases (3.2%), while four cases (6.3%) did not survive.
ConclusionA specialist should supervise topical corticosteroid administration, and parents need to be fully informed about the proper usage and potential side effects to avoid iatrogenic CS and other complications.
Honar O. Kareem, Bilal A. Mohammed, Karzan M. Hasan, Shaho F. Ahmed, Fahmi H. Kakamad, Hawbash M. Rahim, Berun A. Abdalla, Shvan H. Mohammed
Introduction Pituitary stalk interruption syndrome is an exceedingly rare congenital abnormality affecting the pituitary gland that is still not fully understood. This study presents a 7-year-old child with the disease. Case presentation A 7-year-old male child was presented with short stature, school performance…
Pituitary Stalk Interruption Syndrome in a Child: A Rare Case Report with Literature Review
Honar O. Kareem, Bilal A. Mohammed, Karzan M. Hasan, Shaho F. Ahmed, Fahmi H. Kakamad, Hawbash M. Rahim, Berun A. Abdalla, Shvan H. Mohammed
IntroductionPituitary stalk interruption syndrome is an exceedingly rare congenital abnormality affecting the pituitary gland that is still not fully understood. This study presents a 7-year-old child with the disease.
Case presentationA 7-year-old male child was presented with short stature, school performance postponement, and an intellectual disability at a mild level. At 6.5 years of age, he had no facial features, was wearing eyeglasses, and had a weight and height of 20 kg (25th percentile) and 101 cm (3rd percentile), respectively. At the age of 7 years, his height was 117 cm (10th percentile) and his weight was 25 kg (50th percentile). Most laboratory tests were normal. However, insulin-like growth factor-1 and glucagon levels were low. A dynamic magnetic resonance imaging of the pituitary gland revealed an ectopic posterior pituitary lobe and the absence of a pituitary stalk. The patient was put on hormone replacement therapy (Norditropin pen) to control the growth hormone deficiency, and he was put under a close follow-up to monitor growth and panhypopituitarism.
ConclusionAlthough hormone replacement therapy is associated with satisfactory outcomes in treating the syndrome, lifelong follow-up is indicated as new hormone deficiencies may arise later in life.
