Iatrogenic Cushing's syndrome caused by nasal steroid drops

Nasal steroid drops can produce iatrogenic Cushing's syndrome if the recomm ended dose is exceeded. We now report a 19-year-old male patient for whom d examethasone nasal drops were prescribed because of nasal obstruction. He h ad been using these drops for more than 5 years, with a daily dexamethasone dose of 0.7-1.0 mg. It is likely that significant amounts of dexamethasone were swallowed and absorbed by the patient's gastrointestinal tract. As a consequence, the patient developed Cushing's syndrome with panhypopituitari sm, growth retardation, osteoporosis and hypertension. A boyish size of the larynx resulted in a fundamental speaking frequency of a child. After disc ontinuing the intranasal use of the of dexamethasone and adjusting doses of hydrocortisone over 3.5 months a normalization of endocrine function occur red with the beginning of puberty and normal sexual changes. These findings show that the use of nasal steroid drops particularly in children should b e limited to a short period and drugs with a low absorption dose employed.