Elsevier

Ophthalmology

Volume 111, Issue 2, February 2004, Pages 389-395
Ophthalmology

Original article
Adrenal suppression and failure to thrive after steroid injections for periocular hemangioma

https://doi.org/10.1016/S0161-6420(03)00833-9Get rights and content

Abstract

Purpose

To evaluate the effects of steroid injections for periocular capillary hemangioma on adrenal function and body composition.

Design

Noncomparative, interventional case series.

Participants

Four patients with periocular hemangioma.

Methods

Four white female infants with sight-threatening periocular hemangiomata received a combination of steroid injections of triamcinolone and betamethasone. In the first 2 cases, injections were perilesional and in the other 2, intralesional.

Main outcome measures

The infants were monitored by serial measurements of basal serum cortisol concentrations, responses to the Synacthen stimulation test, measurement of growth and of weight gain, and, in one case, more detailed anthropometric measures of body composition.

Results

Prolonged suppression of circulating serum cortisol concentrations and cortisol responses to the Synacthen stimulation test were noted in 3 cases, and marked failure to thrive was noted in all 4 cases.

Conclusions

Adrenal suppression after steroid injection for periocular capillary hemangioma is a potentially life-threatening complication. Failure to thrive is also a frequent side effect of treatment. Ophthalmologists should undertake the above treatment in consultation with a pediatric endocrinologist.

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.

References (21)

There are more references available in the full text version of this article.

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