Factitious hypertension with mineralocorticoid excess in an infant

Helv Paediatr Acta. 1983 May;38(2):185-9.


A 2-month-old breast-fed baby is described, who, admitted for a prolongation of the QT interval on ECG, was found to be severely hypokalemic, alkalotic and hypertensive (blood pressure 200/100 mm Hg). Marked generalized hypotonia was present, and length was less than 3% for age. The results of endocrinological evaluation showed profound suppression of the pituitary-adrenal function and of the renin-aldosterone mechanism. CT scan, cavography and pyelography were normal. A pharmacological cause for the symptoms was sought and found: the mother had been using for the care of bruised nipples a cream containing 1% 9-alpha-fluoroprednisolone-21-acetate. Blood pressure remained elevated for 6 months, but became normal after one year, and growth has resumed normally. The possible differential diagnoses are considered, and the risks presented by topical steroids are emphasized.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Gland Diseases / diagnosis
  • Adult
  • Breast Feeding
  • Diagnosis, Differential
  • Female
  • Fluprednisolone / adverse effects
  • Fluprednisolone / analogs & derivatives*
  • Humans
  • Hypertension / chemically induced*
  • Hypokalemia / chemically induced*
  • Infant
  • Mineralocorticoids / blood*


  • Mineralocorticoids
  • isoflupredone acetate
  • Fluprednisolone