Endocrine Abstracts

Introduction: Psoriasis is a chronic skin disease with a prevalence of 0.6 to 4.8%. Among the possible treatments, we highlight topic corticosteroids that can cause not only different local side effects (skin fragility and atrophy, striae, purpura, acne, telangiectasia, hypertrichosis) but also systemic side effects, including diabetes mellitus (DM), hypertension (HT), Cushing’s syndrome and hypothalamic–pituitary–adrenal (HHA) axis suppression.

Case report: A male patient 47 years old, smoker, with psoriasis for nearly 20 years, followed in the Dermatology consultation and medicated for over 10 years with Dermovate ointment 0.5 mg/g (clobetasol) – once or twice a week and Psodermil ointment 0.5 mg/g+30 mg/g (betamethasone+salicylic acid) – once a week. He was sent to the morbid obesity consultation by his family doctor. He had obesity (BMI=37.4 kg/m²), DM probably secondary to corticosteroid and HT. The patient reported fatigue, muscle weakness and myalgia when he stopped applying the topical corticosteroids. In the physical exam he had a cushingoid phenotype and exuberant psoriatic lesions that occupied most of the trunk and upper limbs. The analytic baseline study revealed early morning plasma cortisol=0.63 μg/dl (n: 6.2–19.4), early morning plasma ACTH=9.9 ng/l (n<63) and urinary free cortisol=10.9 μg/24 h (n: 36–137). Hydrocortisone was started (10+5 mg). The ACTH stimulation test with 250 μg of tetracosactide infused i.v. (without taking the morning dose in the day of the analytic study and the evening dose in the day before): cortisol 0′=3.8 μg/dl and cortisol 60′=9.2 μg/dl. The diagnosis of adrenal insufficiency secondary to corticosteroid therapy was confirmed and hydrocortisone therapy was continued at the dose mentioned above.

Conclusion: This case highlights the possibility of HHA axis suppression in patients with prolonged application of topic corticosteroids that if not diagnosed may have serious consequences.