title: Cushing's syndrome after intra-articular and intradermal administration of triamcinolone acetonide in three pediatric patients.
abstract: BACKGROUND
  Intra-articular and intradermal steroids are often used for their antiinflammatory effect. There is limited experience with intra-articular and intralesional administration of corticosteroids in the pediatric age group.
  
  
  METHODS
  We performed a retrospective chart review of 3 pediatric patients who developed Cushing's syndrome after local administration of triamcinolone acetonide (TCA).
  
  
  RESULTS
  Two females 9 and 17 years old, received intra-articular injections of TCA. One patient received multiple injections of TCA into the interphalangeal joints (cumulative dose: 120 mg), whereas the other received a single injection of 40 mg, a dose that is considered to be in the therapeutic range, into the hip joint. The third patient, a 7-year-old female, received multiple intralesional injections of TCA. These patients developed signs and symptoms of hypercortisolism that appeared 4 to 6 weeks after local administration of TCA and lasted for 4 to 6 months after the last dose of TCA. TCA was detectable in the plasma and urine by the liquid chromatography/tandem mass spectrometry method 4 to 5 months after the last dose of the steroid.
  
  
  CONCLUSIONS
  We noted evidence for Cushing's syndrome in 3 pediatric patients after intra-articular or intradermal administration of TCA. One of them had received a therapeutic dose of TCA. The possibility of hypothalamic-pituitary-adrenal axis suppression should be considered in patients who have received intra-articular or intradermal steroid injections, particularly in those who have had multiple or relatively high doses.
authors.affiliation: Division of Pediatric Endocrinology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Kumar
authors.forename: Ravinder J
authors.initials: RJ
authors.lastname: Singh
authors.forename: Ann M
authors.initials: AM
authors.lastname: Reed
authors.forename: Aida N
authors.initials: AN
authors.lastname: Lteif
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy; D002648:Child; D003480:Cushing Syndrome / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007270:Injections, Intra-Articular; D007271:Injections, Intradermal; D007627:Keloid / Q000188:drug therapy; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use / Q000652:urine
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D006854:Hydrocortisone