Original articleAdrenal suppression and failure to thrive after steroid injections for periocular hemangioma☆
Section snippets
Materials and methods
We report 4 cases of sight-threatening periocular hemangioma that were treated by steroid injections. After observing adrenal suppression and failure to thrive in the first case, the other 3 cases were monitored prospectively by measurement of serum cortisol, responses to a Synacthen test (Alliance Pharmaceuticals Ltd., Chippenham, United Kingdom), measurement of height and weight, and, in one case, measurement of body composition.
Synacthen is a synthetic adrenocorticotrophic hormone analog.
Patient 1
A 4-month-old girl was examined for a progressively enlarging periocular capillary hemangioma on the left side of her forehead and her left upper eyelid, which completely occluded her visual axis (Fig 1A). A computed tomography scan showed a large enhancing mass involving the upper lid and left orbit reaching the orbital apex and extending into the cheek and upper forehead. Treatment was initiated to prevent stimulus deprivational amblyopia. A 1-ml triamcinolone acetonide (Bristol-Myers Squibb
Discussion
Local steroid injections for treatment of sight-threatening periocular hemangiomata were first described by Kushner3 in 1979 and have been used successfully by others.10, 11, 12 Steroid injections are not without adverse side effects. Eyelid necrosis,13 linear subcutaneous fat atrophy,14 local fat atrophy,15 and central retinal artery occlusion16 have been reported. Visual loss resulting from retinal vascular embolism and vessel spasm also have been seen after intranasal steroid injection.17
Acknowledgements
The authors thank F. Cowan, J. Warner, and R. Puttha for obtaining body composition measurements.
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2014, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :A cushingoid appearance has ranged from 1 to 3% in some series,10,14,15 while other studies have not noted cushingoid changes.11,16,17 Adrenal suppression and failure to thrive have been reported following injection of infantile hemangiomas, but these studies used large amounts of triamcinolone and betamethasone (triamcinolone equivalent dose of 4–10 mg/kg per injection).11,12,19 None of the patients in our series exhibited signs of systemic absorption of corticosteroid (e.g., cushingoid features, failure to thrive, growth deceleration), likely because we only treated localized lesions and used a lower dose of corticosteroid (mean 1.6 mg/kg per injection).
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2013, Facial Plastic Surgery Clinics of North AmericaCitation Excerpt :Until recently, corticosteroids have remained the first line of therapy for the treatment of complicated hemangiomas.29,30 Currently, the 2 indications for the use of corticosteroids in the treatment of infantile hemangiomas is for those patients who fail propranolol treatment or for intralesional injection in small focal hemangiomas.31 Local injection is especially effective in the periorbital region, nasal tip, and subglottic region.
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Manuscript no. 220564.