Adrenal Suppression in Infants Treated with Topical Ocular Glucocorticoids.
Ophthalmology
; 125(10): 1638-1643, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-29934270
ABSTRACT
PURPOSE:
To analyze the incidence of adrenal suppression and the glucocorticoid (GC) dose per kilogram body weight given in infants treated with standard protocol for topical ophthalmic GCs after congenital cataract surgery.DESIGN:
Retrospective, consecutive case series.PARTICIPANTS:
All children younger than 2 years of age who underwent operation for congenital cataract between January 2011 and May 2015 in 1 center.METHODS:
Patient charts were reviewed to collect data on results and timing of a standard corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test and GC dose per kilogram body weight. MAIN OUTCOMEMEASURES:
Incidence of adrenal suppression in children tested on GC treatment. Glucocorticoid dose per kilogram body weight.RESULTS:
Among 26 consecutive infants, 15 (58%) were tested while they were still on GC treatment. Ten of these 15 infants (67%) had adrenal suppression, 2 of whom had obvious clinical signs of Cushing's syndrome and 1 of whom had signs of Addisonian crises during general anesthesia. Eleven of the 26 infants (42%) were tested at a median time of 21 days (range, 6-89) after treatment cessation, and they all had normal test results. Children with suppressed adrenal function had received cumulative GC doses per body weight that were significantly higher the last 5 days before testing compared with children with normal test results. Infants with adrenal suppression were treated with hydrocortisone replacement therapy. Adrenal function recovered after a median of 3.1 months (range, 2.3 months to 2.3 years).CONCLUSIONS:
Two thirds of the infants tested during treatment with a standard GC protocol after congenital cataract surgery showed adrenal suppression. There was a significant association between the cumulative daily dose of GCs and the test result. 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Catarata
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Extração de Catarata
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Hormônio Adrenocorticotrópico
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Síndrome de Cushing
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Glucocorticoides
Tipo de estudo:
Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Child, preschool
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Female
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Humans
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Infant
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Male
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article