title: Moderate dose inhaled corticosteroid-induced symptomatic adrenal suppression: case report and review of the literature.
abstract: Inhaled corticosteroids (ICS) are drugs of choice for persistent asthma. Less than 500 µg/d of fluticasone are believed to be safe. We found 92 cases of adrenal suppression in PubMed; among these cases there were 13 children who took 500 µg/d or less of fluticasone. Adrenal insufficiency was diagnosed in a 7-year-old boy on 460 µg ICS for 16 months, with a diagnosis of chronic persistent asthma. A random cortisol was nondetectable as was an early morning cortisol. ICS have greatly improved the day-to-day lives of children with chronic persistent asthma. Parents of children younger than 12 years, who use at least 400 µg of inhaled fluticasone (or bioequivalent), must be given oral and written instructions about warning symptoms of hypocortisolism. Major stress such as surgery, gastrointestinal, bronchopulmonary, or other systemic infections, and heat stress may mandate a written plan of action for use by hospital physicians.
authors.affiliation: Inova Fairfax Hospital for Children, Falls Church, VA, USA. rhs738@aol.com
authors.forename: Richard H
authors.initials: RH
authors.lastname: Schwartz
authors.forename: Otilia
authors.initials: O
authors.lastname: Neacsu
authors.forename: David P
authors.initials: DP
authors.lastname: Ascher
authors.forename: Oral
authors.initials: O
authors.lastname: Alpan
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004338:Drug Combinations; D000068298:Fluticasone; D000068297:Fluticasone-Salmeterol Drug Combination; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D056687:Off-Label Use
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D000068298:Fluticasone; D000420:Albuterol; D006854:Hydrocortisone