Iatrogenic Cushing Syndrome With Hypothalamic-Pituitary-Adrenal Axis Suppression in a Two-Month-Old Infant Following Unsupervised Topical Corticosteroid Use: A Case Report
- 1Neuropediatrics and Neurometabolic Diseases Unit, Children's Hospital of Rabat, Rabat, MAR
- 2Pediatric Diabetology and Endocrinology Unit, Children's Hospital of Rabat, Rabat, MAR
- 3Dysmorphology Unit, Children's Hospital of Rabat, Rabat, MAR
Abstract
Topical corticosteroids are commonly prescribed in pediatric dermatology; however, systemic adverse effects may occur rapidly in infants due to increased percutaneous absorption, the occlusive effect of diapers, and the immaturity of the hypothalamic-pituitary-adrenal (HPA) axis. We report the case of a two-month-old, 6 kg male infant who developed iatrogenic Cushing syndrome following approximately seven weeks of daily and repeated unsupervised application of a betamethasone valerate 0.1% topical corticosteroid to the diaper area for the treatment of diaper rash. Clinical examination revealed moon facies, a buffalo hump, and facio-truncal obesity. Laboratory evaluation showed suppressed morning cortisol at 5 µg/L (reference: 50-230 µg/L) and undetectable adrenocorticotropic hormone (ACTH) at 2.47 pg/mL (reference: 7-63 pg/mL), consistent with secondary adrenal insufficiency due to HPA axis suppression; brain CT showed no structural abnormality of clinical relevance. Management consisted of gradual withdrawal of the topical corticosteroid over four weeks, physiologic hydrocortisone replacement therapy at 8-10 mg/m²/day in three divided doses, and close clinical and biochemical follow-up. Biochemical recovery was suggested by normalization of morning cortisol to 272 µg/L, allowing progressive tapering and the discontinuation of hydrocortisone over six weeks without any episode of acute adrenal insufficiency. The family received structured education regarding the risks of unsupervised corticosteroid use and the warning signs of adrenal crisis. This case underscores that even moderate-to-potent topical corticosteroids applied to occluded skin areas can cause significant systemic toxicity in this vulnerable population and highlights the critical importance of parental education, appropriate prescribing guidance, and vigilant monitoring to prevent this avoidable complication.
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BibTeX
@article{bendouz2026iatrogenic,
title = {{Iatrogenic Cushing Syndrome With Hypothalamic-Pituitary-Adrenal Axis Suppression in a Two-Month-Old Infant Following Unsupervised Topical Corticosteroid Use: A Case Report}},
author = {Soukaina Bendouz and Hind Lachraf and Houda Bella and Zineb Imane and Asmaa Mdaghri Alaoui},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117817},
url = {https://europepmc.org/article/PMC/PMC13754057},
note = {CC BY},
}
RIS
TY - JOUR
TI - Iatrogenic Cushing Syndrome With Hypothalamic-Pituitary-Adrenal Axis Suppression in a Two-Month-Old Infant Following Unsupervised Topical Corticosteroid Use: A Case Report
AU - Soukaina Bendouz
AU - Hind Lachraf
AU - Houda Bella
AU - Zineb Imane
AU - Asmaa Mdaghri Alaoui
PY - 2026
DA - 2026/10/12
JO - Cureus
DO - 10.7759/cureus.117817
UR - https://europepmc.org/article/PMC/PMC13754057
AB - Topical corticosteroids are commonly prescribed in pediatric dermatology; however, systemic adverse effects may occur rapidly in infants due to increased percutaneous absorption, the occlusive effect of diapers, and the immaturity of the hypothalamic-pituitary-adrenal (HPA) axis. We report the case of a two-month-old, 6 kg male infant who developed iatrogenic Cushing syndrome following approximately seven weeks of daily and repeated unsupervised application of a betamethasone valerate 0.1% topical corticosteroid to the diaper area for the treatment of diaper rash. Clinical examination revealed moon facies, a buffalo hump, and facio-truncal obesity. Laboratory evaluation showed suppressed morning cortisol at 5 µg/L (reference: 50-230 µg/L) and undetectable adrenocorticotropic hormone (ACTH) at 2.47 pg/mL (reference: 7-63 pg/mL), consistent with secondary adrenal insufficiency due to HPA axis suppression; brain CT showed no structural abnormality of clinical relevance. Management consisted of gradual withdrawal of the topical corticosteroid over four weeks, physiologic hydrocortisone replacement therapy at 8-10 mg/m²/day in three divided doses, and close clinical and biochemical follow-up. Biochemical recovery was suggested by normalization of morning cortisol to 272 µg/L, allowing progressive tapering and the discontinuation of hydrocortisone over six weeks without any episode of acute adrenal insufficiency. The family received structured education regarding the risks of unsupervised corticosteroid use and the warning signs of adrenal crisis. This case underscores that even moderate-to-potent topical corticosteroids applied to occluded skin areas can cause significant systemic toxicity in this vulnerable population and highlights the critical importance of parental education, appropriate prescribing guidance, and vigilant monitoring to prevent this avoidable complication.
SN - 2168-8184
ER -