Читать книгу Ridley's The Vulva - Группа авторов - Страница 185

Suppression of the hypothalamic–pituitary–adrenal (HPA) axis leading to iatrogenic Cushing’s syndrome can occur if large amounts of a potent steroid are used on large areas continuously, but this systemic effect is exceptionally rare with the amounts used on the vulva. Reports of Cushing’s syndrome have been described in children, but in all cases there was excessive, unsupervised use [12,13], with one case using 60g of an ultra‐potent steroid in 8 weeks, far in excess of recommended amounts. Cushing’s can present with central obesity, a buffalo hump, purpura and striae, proximal muscle weakness, osteoporosis, hyperglycaemia, and sometimes psychiatric disturbance. Investigation with a synacthen test will confirm the diagnosis, and referral for endocrinological advice on management is needed.