Iatrogenic Cushing syndrome and secondary adrenal insufficiency due to intranasal steroids is rare in children. A 7 year old boy was referred to the paediatric endocrine clinic with suspected Cushing syndrome. He presented with excessive weight gain, marked striae and hypertension. His GP had performed a morning cortisol 99.6th centile); height 124.6 cm (50th-75th centile), body mass index (BMI) 30 kg/m2 (>99.6th centile) and blood pressure was 124/72 mmHg (>99th centile).The drug history was reviewed in detail by our Paediatric Pharmacist and revealed that over the past 20 months, he had been using betamethasone nasal drops continuously, prescribed at a dose of 2 drops, twice daily, into each nostril. A total of 38 repeat prescriptions had been dispensed and he had been taking double the prescribed amount per month. The duration of use (20 months) also far exceeded the recommended indication (4–6weeks max). Laboratory investigations: blood glucose 4.7 mmol/L, early morning cortisol Conclusion We describe a case of iatrogenic Cushing syndrome and adrenal insufficiency secondary to administration of long-term high-dose betamethasone nasal drops. Very few cases to date have been reported in the literature in children. Cushing syndrome caused by intranasal steroids is a rare event and more commonly occurs after oral or topical steroid use. Our patient was taking double the recommended dose for more than 20 months. Paediatricians must be aware of the complications of nasal steroid administration and long-term use should be avoided
