title: Hydrocortisone malabsorption due to polyethylene glycols (Macrogol 3350) in a girl with congenital adrenal insufficiency.
abstract: BACKGROUND
  Primary adrenal insufficiency is relatively rare in children and, if unrecognized, may present with cardiovascular collapse, making it a potentially life-threatening entity.
  
  
  METHODS
  The proposita, 11 months old of age, was admitted for lethargy and severe dehydration. Blood pressure was 62/38 mm Hg, and biochemical measurements showed hyponatraemia, hypochloraemia, hyperkalaemia, and metabolic acidaemia. Renin activity was 1484 μU/mL; cortisol, 1.03 μg/dL (normal, 5-25 μg/dL); and corticotropin (ACTH), 4832 ng/L (normal, 9-52 ng/L). Adrenal deficiency was diagnosed, and replacement therapy with glucocorticoids and mineralocorticoids was initiated. After 40 days, ACTH was 797 ng/L. During follow-up, the patient started taking macrogol twice daily for constipation and experienced a significant increase in ACTH (3262 ng/L), which dropped to 648 ng/L when macrogol was stopped. After arbitrary reintroduction of macrogol, the child presented with hypoglycaemia, lethargy, weakness, and hypotonia; ACTH was 3145 ng/L. After again stopping macrogol, her ACTH was near normalized (323 ng/L).
  
  
  CONCLUSIONS
  Hydrocortisone malabsorption may be caused by macrogol use. Because chronic constipation is frequently reported in children, the possibility that macrogol contributes to adrenal crisis should be taken in account.
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. stefano.stagi@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stagi
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. paolodelgreco@yahoo.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Greco
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. frank8622@hotmail.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Ricci
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. chiara.iurato@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Iurato
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. giovanni.poggi@meyer.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Poggi
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. seminara@unifi.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Seminara
authors.affiliation: Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. maurizio.demartino@unifi.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications / Q000151:congenital*; D002648:Child; D003248:Constipation / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008286:Malabsorption Syndromes / Q000139:chemically induced* / Q000378:metabolism; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D011092:Polyethylene Glycols; D006854:Hydrocortisone