An 18-month-old male child presented with genralized obesity, moon facies (Fig. 1), buffalo hump (Fig. 2) and purplish striae over the abdomen, hips and thighs. There was hypertrichosis on the face and trunk. The child weighed 13 kg (over 97th percentile) and had a supine length of 69 cm (below 3rd per centile). His blood pres- sure was 160/100 mm Hg at the time of admission. Urinary excretion of free cortisol was 20 μg/24h which is at the lower limit of normal. An X-ray of the left wrist revealed 3 carpal centres. CT Scan of abdomen showed normal shape and size of the adrenals and CT Scan of brain was normal.

 

Fig. 1. Note the generalized obesity, moon facies, hypertrichosis.	Fig. 2. Photograph showing the buffalo hump.

There was history of recurrent episodes of cough and respiratory distress since 4 months of age. The infant was prescribed betamethasone drops at 4 months of age for the first episode of respiratory distress. Since then the mother had been administering these drops to the child for 5 to 6 days at a time on her own whenever the child had cough and cold. An estimated 15 phials (containing 112.5 mg of betamethasone) were consumed by the infant during the past 14 months. The hypertension normalized after stoppage of steroid administration. This vivid account reiterates the need to prevent indiscriminate use of drugs.

Sutapa Ganguly,
Sucharita Dutta,
Sandeep Chakraborty,
Jyotirmoy Ghosh,
Department of Pediatric Medicine,
I.P.G.M.E.R. and S.S.K.M. Hospital,
Calcutta 700020,
India.