SUN-422 Topical Steroid Induced Cushing Syndrome with Adrenal Insufficiency in a Pediatric Patient

Abstract Disclosure: H.T. Lo: None. Glucocorticoids are used in the management of many childhood diseases, most commonly as anti-inflammatory agents. Cushing syndrome is a rare condition in children, caused by excessive exposure to endogenous, or more commonly, exogenous sources of glucocorticoids. Although rare, long-term use of highly potent topical corticosteroids may lead to the development of Cushing syndrome. Additionally, secondary adrenal insufficiency occurs when chronic exposure to exogenous corticosteroids suppresses the hypothalamic-pituitary-adrenal axis. A 9 year old Filipino boy was brought in for consult due to acne and stretch marks. Two years prior to consultation, he was diagnosed with atopic dermatitis and was prescribed betamethasone ointment, which he applied for five months. There was persistence and progression of the erythematous skin lesions. He was brought to another physician and clobetasol propionate 0.05% ointment was prescribed. His mother applied clobetasol propionate 0.05% ointment on the skin lesions regularly for seven months without subsequent follow up. Several weeks prior to consultation, he also experienced increased appetite, polyuria, polydipsia, easy fatigability and daytime sleepiness. On examination, he was stunted (height z score <-2) and severely obese (BMI z score >+3). Blood pressure was normal. He had cushingoid features such as hirsutism, moon facies, facial plethora, buffalo hump, multiple acne on the face and the back, violaceous striae on the trunk and extremities, central obesity and proximal wasting. He also had acanthosis nigricans on the neck and underarms. Laboratory work up showed elevated HbA1c (6.6%), normal fasting blood sugar, elevated triglyceride level (1.96mmol/L), low HDL level (1.16 mmol/L) and a normal LDL level (0.92mmol/L). Basal morning serum cortisol (86.2 nmol/L) and 24hr urine free cortisol (3μg/24hr) were both low. Alanine transferase level (27.53 U/L) was slightly elevated. He was started and maintained temporarily on metformin treatment. Intensive health behavioral and lifestyle treatment was also advised. He was co-managed with the dermatology service. Clobetasol propionate treatment was discontinued. He was started on tretinoin 0.025% cream, barrier cream, vitamin C serum and phototherapy. To address the adrenal insufficiency, hydrocortisone was given in physiologic dose and was discontinued after three months, after a recovery of the basal morning serum cortisol was documented. There was gradual resolution of Cushingoid features over the next several months. The case highlights the importance of judicious use of corticosteroids in the treatment of skin conditions. Selecting less potent steroids, limiting the duration of exposure and using steroid sparing medications should be considered. In addition, parental education regarding close monitoring of treatment and potential side effects cannot be overemphasized. Presentation: Sunday, July 13, 2025