EXPERIENCE AND REASON |
Cushing’s Syndrome After Intra-articular and Intradermal Administration of Triamcinolone Acetonide in Three Pediatric Patients
* Divisions of Pediatric Endocrinology
Endocrine Laboratory
Rheumatology, Mayo Clinic, Rochester, Minnesota
Background. Intra-articular and intradermal steroids are often used for their antiinflammatory effect. There is limited experience with intra-articular and intralesional administration of corticosteroids in the pediatric age group.
Design/Methods. We performed a retrospective chart review of 3 pediatric patients who developed Cushing’s syndrome after local administration of triamcinolone acetonide (TCA).
Results. Two females 9 and 17 years old, received intra-articular injections of TCA. One patient received multiple injections of TCA into the interphalangeal joints (cumulative dose: 120 mg), whereas the other received a single injection of 40 mg, a dose that is considered to be in the therapeutic range, into the hip joint. The third patient, a 7-year-old female, received multiple intralesional injections of TCA. These patients developed signs and symptoms of hypercortisolism that appeared 4 to 6 weeks after local administration of TCA and lasted for 4 to 6 months after the last dose of TCA. TCA was detectable in the plasma and urine by the liquid chromatography/tandem mass spectrometry method 4 to 5 months after the last dose of the steroid.
Conclusions. We noted evidence for Cushing’s syndrome in 3 pediatric patients after intra-articular or intradermal administration of TCA. One of them had received a therapeutic dose of TCA. The possibility of hypothalamic-pituitary-adrenal axis suppression should be considered in patients who have received intra-articular or intradermal steroid injections, particularly in those who have had multiple or relatively high doses.
Key Words: Cushing’s syndrome • triamcinolone acetonide • intra-articular • intradermal
Abbreviations: TCA, triamcinolone acetonide • LC-MS/MS, liquid chromatography/tandem mass spectrophotometry • ACTH, adrenocorticotropic hormone
Received for publication Feb 27, 2003; Accepted Sep 1, 2003.
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