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Case of the Month: Pediatric ESAP

pediatric esap

This issue highlights Pediatric Endocrine Self Assessment Program. Test your clinical knowledge and prepare for your exam. Available on the online store.

 

Clinical Vignette

You are seeing a 16-year-old girl who just learned that she is pregnant. She is upset because she recently had an allergic skin reaction for which she was given prescription-strength hydrocortisone cream. She used the ointment multiple times a day for several days while unknowingly pregnant. She understands that some hydrocortisone was systemically absorbed and is concerned that the medication has harmed the baby.

Regarding potential harm, you tell her that her fetus is at:

  1. Low risk because hydrocortisone is mostly metabolized by the placenta
  2. Low risk because the fetal ACTH level has been suppressed briefly and should recover quickly
  3. Low risk because the amount of hydrocortisone is insignificant compared with the high levels of maternal cortisol already crossing the placenta
  4. High risk because hydrocortisone crosses the placenta and adversely affects fetal adrenal development
  5. High risk because hydrocortisone crosses the placenta and adversely affects fetal growth


SEE CORRECT ANSWER AND EXPLANATION