Clobetasol misuse
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Clobetasol misuse
Secondary adrenal insufficiency following withdrawal of topical clobetasol, which was being misused from a prolonged duration: case report A 50-year-old woman exhibited secondary adrenal insufficiency as a withdrawal symptom following withdrawal of clobetasol, which was being misused from a prolonged duration for xerosis. The woman was admitted with recurrent episodes of hypoglycaemia for the last 2 months. She had stopped her regular antidiabetic medications (metformin and insulin-glargine). However, the episodes of hypoglycaemia continued to occur at a frequency of once or twice per day. Her medical history was significant for xerosis, dyslipidaemia, gout, hypertension and diabetes mellitus. She had been using topical clobetasol [clobetasol propionate 0.05% diluted in aqueous cream, 200g; amount of drug used for topical application not stated] for xerosis since 2015, which she had stopped 2 months before this presentation [reason for discontinuation not stated]. It was also noted that, clobetasol was prescribed for the topical use on the affected areas of the skin only, and only on ’as required’ basis. However, it was revealed that she had been applying clobetasol all over her body and also on daily basis, which was not as per the prescribed instructions (misuse of clobetasol). At the current presentation, her laboratory investigations revealed the following: normal insulin C-peptide, with low levels of cortisol and adreno-corticotropic hormone. The synacthen test performed to evaluate the hypophyseal–adrenal axis, which revealed an insufficient response, consistent with adrenal insufficiency. An abdomenCT scan revealed no gross pathology. The pituitary MRI was insignificant for pituitary adenoma. Eventually, she was diagnosed with secondary adrenal insufficiency, which might have resulted from withdrawal of the prolonged topical clobetasol use. The woman was therefore treated with hydrocortisone. Eventually, her condition and hypoglycaemia episodes improved. She was advised to use mometasone for the xerosis. At a subsequent follow-up, her condition was found to be improved and hydrocortisone was thus tapered down. Alahmadi HA, et al. Topical steroids induced adrenal insufficiency. Bahrain Medical Bulletin 42: 226-227, No. 3, Sep 2020. Available from: URL: http:// www.bahrainmedicalbulletin.com/SEPT_2020/SEPT2020_TOPICAL.pdf
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Reactions 5 Sep 2020 No. 1820
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