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 Outcome Measures

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.

中文翻译：

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局部眼用糖皮质激素治疗婴儿的肾上腺抑制

目的

分析先天性白内障手术后局部用眼用GC的标准方案治疗的婴儿中肾上腺抑制的发生率和每公斤体重的糖皮质激素（GC）剂量。

设计

回顾性连续案例系列。

参加者

2011年1月至2015年5月在1个中心接受过先天性白内障手术的所有2岁以下儿童。

方法

复查了患者病历表，以收集有关标准促肾上腺皮质激素（促肾上腺皮质激素[ACTH]）刺激试验的结果和时间以及每公斤体重的GC剂量的数据。

主要观察指标

用GC治疗测试的儿童肾上腺抑制的发生率。糖皮质激素的剂量为每公斤体重。

结果

在26名连续婴儿中，有15名（58％）仍在接受GC治疗时接受了测试。这15名婴儿中有10名（67％）患有肾上腺抑制，其中2名有明显的库欣综合症临床症状，其中1名在全身麻醉期间出现Addisonian危机迹象。26名婴儿中有11名（42％）在停止治疗后的中位时间21天（范围6-89）接受了检查，他们的检查结果均正常。肾上腺功能受到抑制的儿童接受测试的每体重的累积GC剂量要比测试结果正常的儿童高得多，在测试前的最后5天。患有肾上腺抑制的婴儿接受氢化可的松替代疗法治疗。中位数3.1个月（范围2.3个月至2.3年）后，肾上腺功能恢复。

结论

先天性白内障手术后接受标准GC方案治疗的婴儿中有三分之二表现出肾上腺抑制作用。GC的每日累积剂量与测试结果之间存在显着关联。由于肾上腺抑制是一种严重但可以治疗的疾病，因此我们建议对与我们的方案相当的局部眼用GC剂量治疗的婴儿进行肾上腺功能的系统评估，并仔细评估其他治疗方案。