Iatrogenic Cushing Syndrome With Glucocorticoid-Induced Adrenal Insufficiency Following Prolonged Topical Clobetasol Use in an Adolescent
4 affiliations
- 1General Medicine, Swansea Bay University Health Board, Swansea, GBR
- 2Pediatric Endocrinology, Swansea Bay University Health Board, Swansea, GBR
- 3Dermatology, Swansea Bay University Health Board, Swansea, GBR
- 4General Medicine, Cwm Taf University Health Board, Bridgend, GBR
Abstract
Potent topical corticosteroids can be absorbed systemically and cause both iatrogenic Cushing syndrome and suppression of endogenous cortisol production. Most paediatric reports involve infants, so clinically important toxicity in adolescents may be overlooked. A 15-year-old girl used clobetasol propionate 0.05% ointment for six months, with a reported cumulative exposure of 250 g and no documented interim clinical review. She developed Cushingoid facial changes, extensive lower-limb striae, fatigue, impaired concentration, insomnia, and low mood. Morning cortisol was <30 nmol/L and ACTH was <5 ng/L. An initial short Synacthen test showed cortisol concentrations of <30 nmol/L at baseline and 30 minutes and 38 nmol/L at 60 minutes, confirming severely impaired adrenal reserve. Clobetasol was discontinued. The patient was started on physiological hydrocortisone replacement, educated on sick-day rules, and supplied with emergency intramuscular hydrocortisone. Serial Synacthen testing showed partial recovery at 2.5 months and adequate adrenal reserve by seven months, allowing hydrocortisone to be discontinued. Her mood subsequently improved, while the striae faded gradually. This case demonstrates a compelling association between prolonged exposure to a very potent topical corticosteroid, clobetasol, and the development of simultaneous Cushingoid features and glucocorticoid-induced adrenal insufficiency in an adolescent. Careful diagnostic review, patient counselling, planned clinical monitoring, and recognition of adrenal suppression are important medication-safety measures when potent or very potent topical corticosteroids are prescribed.
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BibTeX
@article{wong2026iatrogenic,
title = {{Iatrogenic Cushing Syndrome With Glucocorticoid-Induced Adrenal Insufficiency Following Prolonged Topical Clobetasol Use in an Adolescent}},
author = {Pamela Wong and Christopher Bidder and Sairan Whitaker and Krystal Wong},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117155},
url = {https://europepmc.org/article/PMC/PMC13718705},
note = {CC BY},
}
RIS
TY - JOUR
TI - Iatrogenic Cushing Syndrome With Glucocorticoid-Induced Adrenal Insufficiency Following Prolonged Topical Clobetasol Use in an Adolescent
AU - Pamela Wong
AU - Christopher Bidder
AU - Sairan Whitaker
AU - Krystal Wong
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117155
UR - https://europepmc.org/article/PMC/PMC13718705
AB - Potent topical corticosteroids can be absorbed systemically and cause both iatrogenic Cushing syndrome and suppression of endogenous cortisol production. Most paediatric reports involve infants, so clinically important toxicity in adolescents may be overlooked. A 15-year-old girl used clobetasol propionate 0.05% ointment for six months, with a reported cumulative exposure of 250 g and no documented interim clinical review. She developed Cushingoid facial changes, extensive lower-limb striae, fatigue, impaired concentration, insomnia, and low mood. Morning cortisol was <30 nmol/L and ACTH was <5 ng/L. An initial short Synacthen test showed cortisol concentrations of <30 nmol/L at baseline and 30 minutes and 38 nmol/L at 60 minutes, confirming severely impaired adrenal reserve. Clobetasol was discontinued. The patient was started on physiological hydrocortisone replacement, educated on sick-day rules, and supplied with emergency intramuscular hydrocortisone. Serial Synacthen testing showed partial recovery at 2.5 months and adequate adrenal reserve by seven months, allowing hydrocortisone to be discontinued. Her mood subsequently improved, while the striae faded gradually. This case demonstrates a compelling association between prolonged exposure to a very potent topical corticosteroid, clobetasol, and the development of simultaneous Cushingoid features and glucocorticoid-induced adrenal insufficiency in an adolescent. Careful diagnostic review, patient counselling, planned clinical monitoring, and recognition of adrenal suppression are important medication-safety measures when potent or very potent topical corticosteroids are prescribed.
SN - 2168-8184
ER -