High-dose nasal steroid spray linked to Cushing’s Syndrome in young girl
Report details case of Italian child treated with corticosteroids for congestion
Prolonged use of high-dose corticosteroid nasal sprays can lead to Cushing’s syndrome in children, according to a case report on a young girl in Italy who was treated with intranasal betamethasone and mometasone furoate for nasal congestion.
While it’s well known that Cushing’s syndrome can arise as a side effect of oral corticosteroids — especially when used in high doses or over a long time — there have been fewer reports on the risks of corticosteroids when sprayed into the nose.
In addition to Cushing’s syndrome, the girl also developed secondary adrenal insufficiency, which occurs when the adrenal glands located on top of the kidneys don’t produce a sufficient amount of cortisol because the brain’s pituitary gland isn’t releasing enough of a hormone needed to stimulate cortisol production.
“Close pediatric clinical follow-up is required for early detection of side effects,” researchers wrote in “Mometasone Furoate–Induced Iatrogenic Cushing’s Syndrome and Secondary Adrenal Insufficiency: A Case Report,” which appeared in Case Reports in Pediatrics.
Nasal steroid spray prescribed for obstruction
Cushing’s syndrome is an umbrella term that refers to any disease characterized by high levels of cortisol in the body, regardless of the underlying cause. One example is Cushing’s disease, which is caused by a tumor in the brain’s pituitary gland.
In their report, the researchers described the case of an 8-year-old girl who visited the emergency department with fatigue, fast weight gain in three months, slow growth, and excessive body hair growth, or hirsutism. She also had recurrent headaches.
Four months earlier, she had been diagnosed with chronic nasal obstruction, or a blocked nose. She also had obstructive sleep apnea, a condition where her breathing repeatedly stopped and restarted during sleep. She was treated with high doses of intranasal corticosteroids — first betamethasone, then mometasone furoate, with six or more applications per day.
During her exam, she showed classic features of Cushing’s syndrome. These included a rounded face, weight gain in the abdomen and upper body, stretch marks, and excess facial and body hair. Her blood pressure was high for her age, and she had areas of darker skin on her neck and underarms.
Girl was fully recovered after one year
Blood testing revealed high total cholesterol and signs of insulin resistance, which occurs when cells stop responding to insulin, a hormone that moves sugar from the blood into cells. She also had very low levels of cortisol and adrenocorticotropic hormone (ACTH) — the hormone needed to stimulate the production of cortisol.
An ACTH stimulation test, where a small amount of ACTH is given to see if cortisol rises, confirmed her adrenal glands weren’t responding. Imaging studies ruled out any brain or adrenal abnormalities, but showed mild liver enlargement and fat buildup.
She was diagnosed with Cushing’s syndrome caused by the intranasal corticosteroids, along with secondary adrenal insufficiency. This means her adrenal glands had stopped working due to the external source of corticosteroids, which mimic the action of cortisol. She was treated with hydrocortisone as a replacement for cortisol along with vitamin D.
After five months, her adrenal function recovered, and hydrocortisone was stopped after being gradually reduced to avoid a return of nasal symptoms. At a one-year follow-up, she had fully recovered. Her weight and growth improved, and her cholesterol and insulin levels returned to normal.
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