Iatrogenic Cushing Syndrome in a Child With Congenital Adrenal Hyperplasia: Erroneous Compounding of Hydrocortisone
Patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) require lifelong treatment with glucocorticoids. In growing children, the drug of choice is hydrocortisone. Commercially available hydrocortisone tablets do not conform to very low doses prescribed to infants and toddlers,...
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2018-01, Vol.103 (1), p.7-11 |
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| creator | Barillas, Julia E Eichner, Daniel Van Wagoner, Ryan Speiser, Phyllis W |
| description | Patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) require lifelong treatment with glucocorticoids. In growing children, the drug of choice is hydrocortisone. Commercially available hydrocortisone tablets do not conform to very low doses prescribed to infants and toddlers, and compounded hydrocortisone is often dispensed to meet therapeutic needs. However, safety, efficacy, and uniformity of compounded products are not tested. We report a case of Cushing syndrome in a child with CAH who was inadvertently receiving excessive hydrocortisone in compounded form.
A 20-month-old girl with CAH developed growth deceleration, excessive weight for length, irritability, increased facial fat, plethora, and excess body hair while receiving hydrocortisone from a local compounding pharmacy. The signs and symptoms persisted despite decreasing hydrocortisone dose. Iatrogenic Cushing syndrome was suspected. The prescribed hydrocortisone capsules were sent for analysis to the Sports Medicine Research & Testing Laboratory, where testing revealed that each 1-mg hydrocortisone capsule contained five to 10 times the dose prescribed and listed on the label.
Physicians must be aware that errors in compounded medications may lead to unanticipated adverse effects. Iatrogenic Cushing syndrome should be suspected in any child receiving compounded glucocorticoid treatment who develops growth arrest and excess weight gain. |
| doi_str_mv | 10.1210/jc.2017-01595 |
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A 20-month-old girl with CAH developed growth deceleration, excessive weight for length, irritability, increased facial fat, plethora, and excess body hair while receiving hydrocortisone from a local compounding pharmacy. The signs and symptoms persisted despite decreasing hydrocortisone dose. Iatrogenic Cushing syndrome was suspected. The prescribed hydrocortisone capsules were sent for analysis to the Sports Medicine Research & Testing Laboratory, where testing revealed that each 1-mg hydrocortisone capsule contained five to 10 times the dose prescribed and listed on the label.
Physicians must be aware that errors in compounded medications may lead to unanticipated adverse effects. Iatrogenic Cushing syndrome should be suspected in any child receiving compounded glucocorticoid treatment who develops growth arrest and excess weight gain.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2017-01595</identifier><identifier>PMID: 29029106</identifier><language>eng</language><publisher>United States: Copyright Oxford University Press</publisher><subject>Adrenal glands ; Adrenocorticotropic hormone ; Body weight gain ; Case reports ; Cushing syndrome ; Glucocorticoids ; Hydrocortisone ; Hydroxylase ; Hyperplasia ; Infants ; Nervous system diseases ; Pituitary ; Testing laboratories</subject><ispartof>The journal of clinical endocrinology and metabolism, 2018-01, Vol.103 (1), p.7-11</ispartof><rights>Copyright © Oxford University Press 2015</rights><rights>Copyright © 2018 Endocrine Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4475-4c525fc9bb2fb171fc82bf8482ba4da17d176bc6dae961036875ddf7bfcdfaac3</citedby><cites>FETCH-LOGICAL-c4475-4c525fc9bb2fb171fc82bf8482ba4da17d176bc6dae961036875ddf7bfcdfaac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2364241824?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21388,21389,27924,27925,33530,33531,33744,33745,43659,43805,64385,64387,64389,72469,73123,73128,73129,73131</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29029106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barillas, Julia E</creatorcontrib><creatorcontrib>Eichner, Daniel</creatorcontrib><creatorcontrib>Van Wagoner, Ryan</creatorcontrib><creatorcontrib>Speiser, Phyllis W</creatorcontrib><title>Iatrogenic Cushing Syndrome in a Child With Congenital Adrenal Hyperplasia: Erroneous Compounding of Hydrocortisone</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) require lifelong treatment with glucocorticoids. In growing children, the drug of choice is hydrocortisone. Commercially available hydrocortisone tablets do not conform to very low doses prescribed to infants and toddlers, and compounded hydrocortisone is often dispensed to meet therapeutic needs. However, safety, efficacy, and uniformity of compounded products are not tested. We report a case of Cushing syndrome in a child with CAH who was inadvertently receiving excessive hydrocortisone in compounded form.
A 20-month-old girl with CAH developed growth deceleration, excessive weight for length, irritability, increased facial fat, plethora, and excess body hair while receiving hydrocortisone from a local compounding pharmacy. The signs and symptoms persisted despite decreasing hydrocortisone dose. Iatrogenic Cushing syndrome was suspected. The prescribed hydrocortisone capsules were sent for analysis to the Sports Medicine Research & Testing Laboratory, where testing revealed that each 1-mg hydrocortisone capsule contained five to 10 times the dose prescribed and listed on the label.
Physicians must be aware that errors in compounded medications may lead to unanticipated adverse effects. Iatrogenic Cushing syndrome should be suspected in any child receiving compounded glucocorticoid treatment who develops growth arrest and excess weight gain.</description><subject>Adrenal glands</subject><subject>Adrenocorticotropic hormone</subject><subject>Body weight gain</subject><subject>Case reports</subject><subject>Cushing syndrome</subject><subject>Glucocorticoids</subject><subject>Hydrocortisone</subject><subject>Hydroxylase</subject><subject>Hyperplasia</subject><subject>Infants</subject><subject>Nervous system diseases</subject><subject>Pituitary</subject><subject>Testing laboratories</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kT1v1TAUhi0EopfCyIossbC4-DhOHLNVUaGVKjEAgs1y_NHkksTBTlTdf4_T23boUA8-svWcR8d-EXoP9AwY0M97c8YoCEKhlOULtAPJSyJAipdoRykDIgX7c4LepLSnFDgvi9fohEnKJNBqh9KVXmK4cVNvcLOmrp9u8I_DZGMYHe4nrHHT9YPFv_ulw02YNnLRAz630U25Xh5mF-dBp15_wRcxhsmFNWVynMM62U0XfKay0IS49CkDb9Err4fk3t3XU_Tr68XP5pJcf_921ZxfE8O5KAk3JSu9kW3LfAsCvKlZ62ued82tBmFBVK2prHayAlpUtSit9aL1xnqtTXGKPh29cwz_VpcWNfbJuGHQd0MqkCVwEFxCRj8-QfdhjfmBSbGi4oxDzXimyJEyMaQUnVdz7EcdDwqo2tJQe6O2NNRdGpn_cG9d29HZR_rh-zMAR-A2DIuL6e-w3rqoOqeHpXsqJQ9S_kwPzYtXoia5o6aQT2S7Kor_ZgimRg</recordid><startdate>201801</startdate><enddate>201801</enddate><creator>Barillas, Julia E</creator><creator>Eichner, Daniel</creator><creator>Van Wagoner, Ryan</creator><creator>Speiser, Phyllis W</creator><general>Copyright Oxford University Press</general><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201801</creationdate><title>Iatrogenic Cushing Syndrome in a Child With Congenital Adrenal Hyperplasia: Erroneous Compounding of Hydrocortisone</title><author>Barillas, Julia E ; 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In growing children, the drug of choice is hydrocortisone. Commercially available hydrocortisone tablets do not conform to very low doses prescribed to infants and toddlers, and compounded hydrocortisone is often dispensed to meet therapeutic needs. However, safety, efficacy, and uniformity of compounded products are not tested. We report a case of Cushing syndrome in a child with CAH who was inadvertently receiving excessive hydrocortisone in compounded form.
A 20-month-old girl with CAH developed growth deceleration, excessive weight for length, irritability, increased facial fat, plethora, and excess body hair while receiving hydrocortisone from a local compounding pharmacy. The signs and symptoms persisted despite decreasing hydrocortisone dose. Iatrogenic Cushing syndrome was suspected. The prescribed hydrocortisone capsules were sent for analysis to the Sports Medicine Research & Testing Laboratory, where testing revealed that each 1-mg hydrocortisone capsule contained five to 10 times the dose prescribed and listed on the label.
Physicians must be aware that errors in compounded medications may lead to unanticipated adverse effects. Iatrogenic Cushing syndrome should be suspected in any child receiving compounded glucocorticoid treatment who develops growth arrest and excess weight gain.</abstract><cop>United States</cop><pub>Copyright Oxford University Press</pub><pmid>29029106</pmid><doi>10.1210/jc.2017-01595</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adrenal glands Adrenocorticotropic hormone Body weight gain Case reports Cushing syndrome Glucocorticoids Hydrocortisone Hydroxylase Hyperplasia Infants Nervous system diseases Pituitary Testing laboratories |
| title | Iatrogenic Cushing Syndrome in a Child With Congenital Adrenal Hyperplasia: Erroneous Compounding of Hydrocortisone |
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