DR. ASHOK KUMAR SINGH

DR. PANDAV SURINDER SINGH, Dr. FAISAL T. T., Dr. SUSHMITA KAUSHIK

Abstract

Aim: To report iatrogenic Cushing’s syndrome in an infant after routine use of topical steroids post-operatively. Case: A six-week-old boy underwent an uneventful bilateral goniotomy for congenital glaucoma. He was prescribed topical betamethasone0.1% six times daily for two weeks, tapered weekly. Results: At 4-weeks, there was significant weight gain, truncal obesity and hirsutism. Serum ACTH and Cortisol levels were low, suggesting exogenous Cushing’s syndrome. He was started on a maintenance dose hydrocortisone. At 6-months, the serum ACTH & Cortisol levels normalized and the baby reverted to age-appropriate weight. Exome sequencing revealed a missense variant (p.Ala922Val;c.2765C>T) of the USP11 gene. Conclusion: USP 8, a gene of the same family as USP11 has been implicated in Cushing’s syndrome. Bilateral topical steroids may exceed the safe systemic dose. The case highlights the importance of punctal occlusion after instilling eye drops to lower the risk of systemic absorption.

Full Text