Cargando…

Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH

Currently there are no commercially available hydrocortisone formulations for the treatment of children with congenital adrenal hyperplasia (CAH) that allow for smaller doses (0.1-1.25 mg) and incremental adjustments needed to control excess androgen production and avoid the negative effects of over...

Descripción completa

Detalles Bibliográficos
Autores principales: Al-Rayess, Heba, Fleissner, Kristin, Jaber, Mu’taz, Brundage, Richard C, Sarafoglou, Kyriakie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417883/
https://www.ncbi.nlm.nih.gov/pubmed/32803093
http://dx.doi.org/10.1210/jendso/bvaa091
_version_ 1783569586550996992
author Al-Rayess, Heba
Fleissner, Kristin
Jaber, Mu’taz
Brundage, Richard C
Sarafoglou, Kyriakie
author_facet Al-Rayess, Heba
Fleissner, Kristin
Jaber, Mu’taz
Brundage, Richard C
Sarafoglou, Kyriakie
author_sort Al-Rayess, Heba
collection PubMed
description Currently there are no commercially available hydrocortisone formulations for the treatment of children with congenital adrenal hyperplasia (CAH) that allow for smaller doses (0.1-1.25 mg) and incremental adjustments needed to control excess androgen production and avoid the negative effects of overtreatment. This lack of availability has led physicians to recommend dividing hydrocortisone 5-mg tablets into 4 to 6 pieces, compounding capsules or hydrocortisone suspension, or crushing 5- or 10-mg tablets in 5 or 10 mL of water. We report a case of iatrogenic Cushing syndrome in a 6-year 11-month-old girl with salt-wasting CAH treated with hydrocortisone tablets that were administered after crushing and dispersing into water to obtain the prescribed dose. She presented with poor growth, increasing body mass index (BMI), excess downy hair, round facies, and gastric ulcers. Her hydrocortisone dose was 8.1 mg/m(2)/day. Results for all adrenal steroid concentrations were undetectable at 8 am, 12 hours after her last dose. The year prior to presentation her parents began dissolving 10 mg of hydrocortisone in 10 mL of water and using this preparation over the course of 24 hours, which coincided with rapid increase of BMI. We switched her to a pharmacy-compounded alcohol-free hydrocortisone suspension with total daily doses ranging from 6.5 to 8.2 mg/m(2)/day, which resulted in resolution of her cushingoid features, a decrease in BMI, and catch-up growth. Our case highlights that manipulation of hydrocortisone tablets by parents can result in great variability in dosing and the need for commercially available pediatric formulations allowing for smaller dosing required in young children.
format Online
Article
Text
id pubmed-7417883
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-74178832020-08-14 Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH Al-Rayess, Heba Fleissner, Kristin Jaber, Mu’taz Brundage, Richard C Sarafoglou, Kyriakie J Endocr Soc Case Reports Currently there are no commercially available hydrocortisone formulations for the treatment of children with congenital adrenal hyperplasia (CAH) that allow for smaller doses (0.1-1.25 mg) and incremental adjustments needed to control excess androgen production and avoid the negative effects of overtreatment. This lack of availability has led physicians to recommend dividing hydrocortisone 5-mg tablets into 4 to 6 pieces, compounding capsules or hydrocortisone suspension, or crushing 5- or 10-mg tablets in 5 or 10 mL of water. We report a case of iatrogenic Cushing syndrome in a 6-year 11-month-old girl with salt-wasting CAH treated with hydrocortisone tablets that were administered after crushing and dispersing into water to obtain the prescribed dose. She presented with poor growth, increasing body mass index (BMI), excess downy hair, round facies, and gastric ulcers. Her hydrocortisone dose was 8.1 mg/m(2)/day. Results for all adrenal steroid concentrations were undetectable at 8 am, 12 hours after her last dose. The year prior to presentation her parents began dissolving 10 mg of hydrocortisone in 10 mL of water and using this preparation over the course of 24 hours, which coincided with rapid increase of BMI. We switched her to a pharmacy-compounded alcohol-free hydrocortisone suspension with total daily doses ranging from 6.5 to 8.2 mg/m(2)/day, which resulted in resolution of her cushingoid features, a decrease in BMI, and catch-up growth. Our case highlights that manipulation of hydrocortisone tablets by parents can result in great variability in dosing and the need for commercially available pediatric formulations allowing for smaller dosing required in young children. Oxford University Press 2020-07-05 /pmc/articles/PMC7417883/ /pubmed/32803093 http://dx.doi.org/10.1210/jendso/bvaa091 Text en © Endocrine Society 2020. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Al-Rayess, Heba
Fleissner, Kristin
Jaber, Mu’taz
Brundage, Richard C
Sarafoglou, Kyriakie
Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title_full Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title_fullStr Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title_full_unstemmed Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title_short Manipulation of Hydrocortisone Tablets Leads to Iatrogenic Cushing Syndrome in a 6-Year-Old Girl With CAH
title_sort manipulation of hydrocortisone tablets leads to iatrogenic cushing syndrome in a 6-year-old girl with cah
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417883/
https://www.ncbi.nlm.nih.gov/pubmed/32803093
http://dx.doi.org/10.1210/jendso/bvaa091
work_keys_str_mv AT alrayessheba manipulationofhydrocortisonetabletsleadstoiatrogeniccushingsyndromeina6yearoldgirlwithcah
AT fleissnerkristin manipulationofhydrocortisonetabletsleadstoiatrogeniccushingsyndromeina6yearoldgirlwithcah
AT jabermutaz manipulationofhydrocortisonetabletsleadstoiatrogeniccushingsyndromeina6yearoldgirlwithcah
AT brundagerichardc manipulationofhydrocortisonetabletsleadstoiatrogeniccushingsyndromeina6yearoldgirlwithcah
AT sarafogloukyriakie manipulationofhydrocortisonetabletsleadstoiatrogeniccushingsyndromeina6yearoldgirlwithcah