Adrenal suppression may occur in infants treated with topical ocular glucocorticoids
Adrenal suppression is present in two-thirds of infants tested during treatment with a standard glucocorticoid (GC) protocol after congenital cataract surgery, according to a recent study, noting a significant association between cumulative daily dose of GCs and the test result.
Fifteen (58 percent) of 26 consecutive infants were tested while still on GC treatment. Of these, 10 (67 percent) had adrenal suppression, two of whom had obvious clinical signs of Cushing’s syndrome and one of whom had signs of Addisonian crises during general anaesthesia.
Of the 26 infants, 11 (42 percent) were tested at a median time of 21 days (range, 6–89) after treatment cessation. All had normal test results.
Children with adrenal suppression were given cumulative GC doses per body weight that were significantly higher the last 5 days prior to testing vs those with normal test results. Infants with suppressed adrenal function received hydrocortisone replacement therapy and recovered after a median of 3.1 months (range, 2.3 months to 2.3 years).
“Because adrenal suppression is a serious but treatable condition, we recommend a systematic assessment of adrenal function in infants treated with doses of topical ocular GCs comparable to our regimen and careful evaluations of other treatment regimens,” the investigators said.
In this retrospective, consecutive case series, all children aged <2 years who underwent operation for congenital cataract between January 2011 and May 2015 in one centre were included. The investigators reviewed patients charts to obtain data on results and timing of a standard corticotropin (adrenocorticotropic hormone) stimulation test and GC dose per kilogram body weight.