Reactions 1704, p187 - 2 Jun 2018 O S Iatrogenic Cushing’s syndrome secondary to compounding error: case report A 6-month-old-girl developed iatrogenic Cushing’s syndrome following an overdose of hydrocortisone secondary to compounding error [route not stated]. The girl, who had classic salt wasting congenital adrenal hyperplasia (CAH), was born with atypical genitalia. She was diagnosed with 21-hydroxylase deficiency. On day 2 of life, she started receiving hydrocortisone 2.5mg thrice daily, along with fludrocortisone and sodium chloride. The doses of fludrocortisone and hydrocortisone were decreased by six weeks of age. Hydrocortisone was prescribed at a dose of 5mg daily in three divided doses in the form of crushed weighed hydrocortisone tablets in capsules obtained from a local compounding pharmacy. During the first several months of th life, she had been tracking at the 90 percentile. However, she started developing growth deceleration at the age of six months. She had fallen to the first percentile of length by 16 months of age. Her weight was excessive at the st 91 percentile. On physical examination, she was found to have increased facial fat, excess body hair, plethora and irritability. Despite low dose hydrocortisone therapy 1mg thrice daily, her adrenal profile revealed persistent suppression of androstenedione and 17-hydroxyprogesterone. Iatrogenic Cushing’s syndrome was strongly suspected and the hydrocortisone capsule were sent for analysis, which showed that each capsule contained 5–10 times the dose of hydrocortisone than that indicated on the label. Consequently, she received a supra-physiologic dose of hydrocortisone. Thereafter, hydrocortisone was obtained from a different pharmacy. Her growth rate improved and her symptoms resolved gradually. Her Cushing’s syndrome was attributed to an inadvertent overdose of hydrocortisone caused due to compounding error. Author comment: "We report a case of Cushing syndrome in a child with CAH who was inadvertently receiving excessive hydrocortisone in compounded form." Barillas JE, et al. Iatrogenic cushing syndrome in a child with congenital adrenal hyperplasia: Erroneous compounding of hydrocortisone. Journal of Clinical Endocrinology and Metabolism 103: 7-11, No. 1, 01 Jan 2018. Available from: URL: https://doi.org/10.1210/jc.2017-01595 - USA 803322977 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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