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Exophthalmos in Cushing's Syndrome

1958; BMJ; Volume: 2; Issue: 5094 Linguagem: Inglês

10.1136/bmj.2.5094.481

0959-8138

D. C. Morgan, A. Stuart Mason,

Ophthalmology and Eye Disorders

DiscussionThe nephrotic syndrome in children is a fluctuating condition.It is characterized by episodes of exacerbation of proteinuria and oedema.Some children remit spon- taneously, losing oedema and proteinuria permanently.Others continue to pass protein, without impairment of renal function, for long periods.A small proportion die of renal and cardiac failure or other causes.Absence of proteinuria for many months does not preclude a relapse.This makes it impossible to evaluate the results of treatment over short periods.In two of our cases moderate doses of cortisone and prednisone did not affect the proteinuria, while a course of prednisolone produced a marked reduction.As Arneil (1956) and Lennard-Jones (1957) have also shown, predni- solone is the only form of treatment that consistently reduces or abolishes proteinuria in children.Proteinuria may recur many months after successful prednisolone treat- ment-as occurred in two of our children; however, these children responded to a further course.It is suggested that prolonged treatment with small doses of prednisolonefor example, 5 mg. on alternate days-may prevent relapse. SummarySix cases of the nephrotic syndrome in children have been treated with large doses of prednisolone and followed for periods of up to 18 months.Five cases lost their proteinuria, and three of these are protein-free at 6, 15, and 18 months after treatment.Two developed proteinuria and oedema after 3 and 15 months.Both were treated again with a course of prednisolone, with disappearance of oedema and reduction in proteinuria.One further case has continued to pass a decreased amount of protein, which was further decreased after another course of prednisolone.ADDENDUM, A ugust, 1958.-SinceOctober, 1957, three of ten children-D.C., S. T., and T. J.-have had no relapses.P. M. and L. L., when last seen, some months ago, were also well.K. G. has had two more relapses ; each has responded to further short courses of prednisolone (0.5 g. in two weeks).Two other cases have been treated and fol- lowed up for nine and six months respectively.Each re- sponded to the initial course, and was kept on a maintenance dose.One of these had to be readmitted six months after bis initial course, but responded to a short course of pred- nisolone (0.5 g. in two weeks).The latter remains well, but continues to have proteinuria, despite maintenance therapy.