Adrenal suppression secondary to inhaled fluticasone propionate.
BACKGROUND
Inhaled glucocorticoids are the medical treatment of choice in many of patients with asthma. Fluticasone propionate is an inhaled glucocorticoid with little systemic bioavailability via the oral route and infrequent association with systemic adverse effects at the recommended dosage.


OBJECTIVE
To report a case of adrenal suppression and exogenous glucocorticoid excess from inhaled fluticasone propionate.


METHODS
A 9-year-old girl with a previous history of episodic asthma was placed on 550 microg of fluticasone propionate daily for severe labile asthma diagnosed by history and methacholine challenge. The patient returned 6 months later with complaints of increased appetite, nausea, and feeling "hot and flushed." On physical exam she had stigmata of Cushing's syndrome. The patient subsequently developed orthostatic hypotension and moderate dehydration following a viral illness. After a long taper of fluticasone propionate the patient' s adrenal function returned to normal and she had no acute or chronic exacerbations of her asthma.


RESULTS
Her 8 AM cortisol was undetectable with an ACTH of 21 pg/mL. The serum prolactin, TSH, free thyroxine, insulin-like growth factor I, and renin activity were all normal. An MRI study of her head was also normal. Repeat methacholine challenges while receiving a much smaller dose fluticasone propionate showed a significant decrease in airway reactivity.


CONCLUSIONS
Adrenal suppression can occur from inhaled fluticasone propionate at a dosage less than has been previously reported.
Taylor
A V
AV
Mayo Graduate School of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Laoprasert
N
N
Zimmerman
D
D
Sachs
M I
MI
D000280:Administration, Inhalation; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D018926:Anti-Allergic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003864:Depression, Chemical; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D013997:Time Factors
D000730:Androstadienes; D018926:Anti-Allergic Agents; D000068298:Fluticasone