Skip to main content

Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical and subconjunctival corticosteroids following cataract surgery

Graefe's Archive for Clinical and Experimental Ophthalmology volume 259, pages 3159–3165 (2021)Cite this article

Abstract

Purpose

Cushingoid features are occasionally encountered in infants after pediatric cataract surgery. The aim of this study is to evaluate whether the use of topical glucocorticoids (GCs) following congenital cataract surgery can result in endogenous adrenal suppression and/or systemic side effects similar to those seen with systemic steroids.

Methods

A prospective study was performed on 20 infants with bilateral congenital cataract. All infants received a single subconjunctival betamethasone injection of 1 mg at the end of surgery in addition to topical dexamethasone eye drops 1 mg/ml for 6 weeks. All infants had anthropometric measurements and blood pressure measurements, serum cortisol, and ACTH level measurements before surgery and 2 months after. In addition, the total administered glucocorticoid adjusted per weight was calculated.

Results

The mean age of the infants was 4.93 ± 2.58 months. Thirteen were males (65%). The total administered glucocorticoid dose was 18.7 mg and the mean cumulative dexamethasone equivalent dose administered was 2.75 ± 1.31 mg/kg. There was a statistically significant increase in the adjusted weight percentile for age (P = 0.009). Both the systolic and diastolic blood pressure were significantly elevated (P = 0.005 and P = 0.025 respectively). There was a statistically significant reduction in both the morning and afternoon serum ACTH levels (P = 0.023 and P = 0.014). The reduction in serum cortisol levels was statistically non-significant.

Conclusions

Topical steroids following pediatric cataract surgery can result in both subclinical and clinical changes in the hypothalamic–pituitary–adrenal axis that can be easily overlooked and need careful attention and follow-up.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Data availability

Full data are available from the corresponding author upon request.

Code availability

Not applicable.

References

  1. Haargaard B, Wohlfahrt J, Fledelius HC, Rosenberg T, Melbye M (2004) Incidence and cumulative risk of childhood cataract in a cohort of 2.6 million Danish children. Invest Ophthalmol Vis Sci 45(5):1316–20

    Article  Google Scholar 

  2. Fujita K, Kasayama S, Hashimoto J, Nagasaka Y, Nakano N, Morimoto Y, Barnes PJ, Miyatake A (2001) Inhaled corticosteroids reduce bone mineral density in early postmenopausal but not premenopausal asthmatic women. J Bone Miner Res 16(4):782–787

    CAS  Article  Google Scholar 

  3. Decani S, Federighi V, Baruzzi E, Sardella A, Lodi G (2014) Iatrogenic Cushing’s syndrome and topical steroid therapy: case series and review of the literature. J Dermatolog Treat 25(6):495–500

    Article  Google Scholar 

  4. McGhee CN, Dean S, Danesh-Meyer H (2002) Locally administered ocular corticosteroids: benefits and risks. Drug Saf 25(1):33–55

    CAS  Article  Google Scholar 

  5. Sandhu SS, Smith JM, Doherty M, James A, Figueiredo FC (2012) Do topical ophthalmic corticosteroids suppress the hypothalamic pituitary-adrenal axis in post-penetrating keratoplasty patients? Eye (Lond) 26:699–702

    CAS  Article  Google Scholar 

  6. Brown P, Blundell G, Greening A, Crompton G (1991) Hypothalamo-pituitary-adrenal axis suppression in asthmatics inhaling high dose corticosteroids. Respir Med 85(6):501–510

    CAS  Article  Google Scholar 

  7. Güven A, Gülümser O, Ozgen T (2007) Cushing’s syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse? J Pediatr Endocrinol Metab 20(11):1173–1182

    Article  Google Scholar 

  8. Kröger L, Kotaniemi K, Jääskeläinen J (2009) Topical treatment of uveitis resulting in adrenal insufficiency. Acta Paediatr 98(3):584–585

    Article  Google Scholar 

  9. Roberts SM, Lavach JD, Macy DW, Severin GA (1984) Effect of ophthalmic prednisolone acetate on the canine adrenal gland and hepatic function. Am J Vet Res 45(9):1711–1714

    CAS  PubMed  Google Scholar 

  10. Fukuhara D, Takiura T, Keino H, Okada AA, Yan K (2017) Iatrogenic Cushing’s syndrome due to topical ocular glucocorticoid treatment. Pediatrics 139(2):e20161233

    Article  Google Scholar 

  11. Scherrer KS, Weitz M, Eisenack J, Truffer B, Konrad D (2015) Cushing syndrome after bilateral lensectomy. Eur J Pediatr 174:399–401

    Article  Google Scholar 

  12. Chrousos G, Pavlaki AN, Magiakou MA (2011). Glucocorticoid therapy and adrenal suppression. Endotext. http://www.endotext.org/chapter/glucocorticoid-therapy-and-adrenal-suppression/. Accessed 9 April, 2020.

  13. Steelman J, Kappy M (2001) Adrenal suppression and growth retardation from ocular corticosteroids. J Pediatr Ophthalmol Strabismus 38:177–178

    CAS  Article  Google Scholar 

  14. Afandi B, Toumeh MS, Saadi HF (2003) Cushing’s syndrome caused by unsupervised use of ocular glucocorticoids. Endocr Pract 9:526–529

    Article  Google Scholar 

  15. Chiang MY, Sarkar M, Koppens JM, Milles J, Shah P (2006) Exogenous Cushing’s syndrome and topical ocular steroids. Eye (Lond) 20:725–727

    Article  Google Scholar 

  16. Hopkins RL, Matthew MD, Leinung C (2005) Exogenous Cushing’s syndrome and glucocorticoid withdrawal. Endocrinol Metab Clin N Am 34(2):371–384

    CAS  Article  Google Scholar 

  17. Lopez Schmidt I, Lahner H, Mann K, Petersenn S (2003) Diagnosis of adrenal insufficiency: evaluation of the corticotropin-releasing hormone test and basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic-pituitary-adrenal disease. J Clin Endocrinol Metab 88(9):4193–4198

    Article  Google Scholar 

  18. Montes-Villarreal J, Perez-Arredondo LA, Rodriguez-Gutierrez R, Gonzalez-Colmenero AD, Solis RC, González-González JG, Mancillas-Adame LG (2020) Serum morning cortisol as a screening test for adrenal insufficiency. Endocr Pract 26(1):30–35

    Article  Google Scholar 

  19. Ulhaq I, Ahmad T, Khoja A, Islam N (2019) Morning cortisol as an alternative to Short Synecthan test for the diagnosis of primary adrenal insufficiency. Pak J Med Sci 35(5):1413–1416

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmology Department, Faculty of Medicine, Cairo University, 16 Abd El-Hady Street Manial, Cairo, 114511, Egypt

    Abeer Aly, Jylan Gouda, Ahmed Awadein & Dina El-Fayoumi

  2. Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Hend M. Soliman

Authors
  1. Abeer Aly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jylan Gouda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed Awadein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hend M. Soliman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dina El-Fayoumi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Abeer Aly performed the literature review, tabulated the data, and drafted the manuscript. Jylan Gouda collected the clinical data, drafted, and revised the manuscript. Ahmed Awadein contributed to the study design, cleaned, and analyzed the data; did the statistical analysis; and revised the paper. He is the guarantor. Hend M. Soliman contributed to the study design, analyzed the clinical and serological data, and revised the manuscript. Dina El-Fayoumi performed the surgeries, wrote, and revised the manuscript.

Corresponding author

Correspondence to Ahmed Awadein.

Ethics declarations

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee (Cairo University Research Ethics Committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from the guardians of all individual participants included in the study.

Consent for publication

Additional informed consent was obtained from the guardians of all individual participants for whom identifying information is included in this article.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aly, A., Gouda, J., Awadein, A. et al. Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical and subconjunctival corticosteroids following cataract surgery. Graefes Arch Clin Exp Ophthalmol 259, 3159–3165 (2021). https://doi.org/10.1007/s00417-021-05221-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-021-05221-0

Keywords

  • Cushing
  • Cortisol
  • ACTH
  • Congenital cataract
  • Pediatric cataract
  • Topical steroids
  • Exogenous Cushing
  • Ocular steroids