• Topical Ocular Glucocorticoids Cause Adrenal Suppression in Infants

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, October 2018

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    Bangsgaard et al. assessed adrenal suppression among infants who re­ceived topical ocular glucocorticoids (GCs) following surgery for congenital cataract. They found that two-thirds of their study population experienced this adverse effect, which correlated strong­ly with high cumulative doses.

    This retrospective, consecutive case series included patients under 2 years of age who underwent surgery at Copenhagen University Hospital in Denmark. The surgical procedure and GC dosing protocol were standard. The authors reviewed patients’ records and documented outcomes, GC dose per kg of body weight, and the timing of a standard corticotropin (adrenocortico­tropic hormone) stimulation test. The main outcome measure was the inci­dence of adrenal suppression among infants who were tested for it during GC treatment.

    Of the 26 infants who underwent the surgery, 15 (58%) received the cor­ticotropin stimulation test while on GC treatment. Ten (67%) of the 15 infants had adrenal suppression, and the degree of suppression varied widely. Two of these displayed obvious clinical signs of Cushing syndrome, and another had signs of Addisonian crisis while under general anesthesia. Adrenal suppression was treated with hydrocortisone replacement therapy. In the 5 days preceding testing, cumulative GC doses per body weight were significantly higher for the patients with suppressed adrenal function. Recovery of adrenal function occurred after a median of 3.1 months (range, 2.3 months to 2.3 years).

    Eleven (42%) of the 26 infants were tested later, at a median of 21 days (range, 6-89 days) after cessation of GC treat­ment. All test results were normal at that time.

    The authors advocate using the lowest possible dose of topical ocular GCs for the shortest period needed to control inflammation postoperatively. They also advise systematic assessment of ad­renal function when standard GC pro­tocols are utilized, along with careful evaluation of other dosing regimens. (Also see related commentary by Scott R. Lambert, MD, in the same issue.)

    The original article can be found here.