This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.
At the AACE 2017 Annual Meeting, lead study author Kaitlyn Steffensmeier, MS III, of the Dayton Veterans Affairs (VA) Medical Center, Dayton, OH, presented a case study describing a patient “who developed secondary adrenal insufficiency secondary to long-term topical steroid use and who with decreased topical steroid use recovered.”
The patient was a 63-year-old white male with a 23-year history of psoriasis. For 18 years, the patient had been applying Clobetasol Propionate 0.05% topically on several areas of his body every day. Upon presentation to the endocrine clinic for evaluation of his low serum cortisol, the patient complained of a 24-pound weight gain over a 2-year period, feeling fatigued, as well as facial puffiness.
Laboratory analysis found that the patient’s random serum cortisol and ACTH levels were low (0.2µg/dL and <1.1pg/mL, respectively). According to the study authors, “the labs were indicative of secondary adrenal insufficiency.” Additionally, a pituitary MRI “showed a 2mm hypoenhancing lesion within the midline of the pituitary gland consistent with Rathke’s cleft cyst versus pituitary microadenoma.”
The patient was initiated on 10mg of hydrocortisone in the morning and 5mg in the evening and was instructed to decrease the use of his topical steroid to one time per month. For the treatment of his psoriasis, the patient was started on apremilast, a phosphodiesterase-4 enzyme (PDE4) inhibitor, and phototherapy.
After 2.5 years, the patient had a subnormal response to the cosyntropin stimulation test. However, after 3 years, a normal response with an increase in serum cortisol to 18.7µg/dL at 60 minutes was obtained; the patient was then discontinued on hydrocortisone. Additionally, a stable pituitary tumor was shown via a repeat pituitary MRI.
The study authors explained that, although secondary adrenal insufficiency is not commonly reported, “one study showed 40% of patients with abnormal cortisol response to exogenous ACTH after two weeks of topical glucocorticoids usage.” Another meta-analysis of 15 studies (n=320) revealed 4.7% of patients developing adrenal insufficiency after using topical steroids. Because of this, “clinicians need to be aware of potential side effects of prolong topical steroid use,” added the study authors.
For continuous endocrine news coverage from the AACE 2017 Annual Meeting, check back to MPR’s AACE page for the latest updates.
From http://www.empr.com/aace-2017/topical-steroid-psoriasis-clobestasol-propionate/article/654335/
Filed under: adrenal, Meetings and Conferences, pituitary | Tagged: AACE 2017 Annual Meeting, ACTH, adrenal insufficiency, American Association of Clinical Endocrinologists, Clobetasol Propionate, lesion, microadenoma, MRI, pituitary, psoriasis, Rathke’s cleft cyst, serum cortisol, topical steroid | Leave a comment »
Dr. John Carmichael is the Co-Director of the USC Pituitary Center and Associate Professor of Clinical Medicine at the Keck School of Medicine at the University of Southern California. After earning a degree in biomedical ethics at Brown University, Dr. Carmichael graduated from the Medical College of Virginia in Richmond. He then completed internship and residency at Virginia Mason Medical Center in Seattle, Washington. He received his endocrinology fellowship training at NYU, where he received a research fellowship grant to conduct clinical trials devoted to growth hormone deficiency and acromegaly after his clinical fellowship. In 2006, he moved to Los Angeles to join the Pituitary Center at Cedars-Sinai Medical Center, where he cared for patients with pituitary disease, devised and conducted clinical trials, and taught medical students, residents, and endocrinology fellows. In 2014, he joined the faculty at the University of Southern California. He has authored several journal articles devoted to clinical pituitary medicine, book chapters covering hypopituitarism and hypothalamic disease, and sits on the editorial boards for Pituitary and Endocrine, Diabetes, and Metabolism Case Reports.
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