title: Adrenal Insufficiency after Chronic Swallowed Glucocorticoid Therapy for Eosinophilic Esophagitis.
abstract: OBJECTIVE
  To establish the prevalence of adrenal insufficiency (AI) in children with eosinophilic esophagitis treated with swallowed fluticasone propionate (FP) or budesonide.
  
  
  METHODS
  Children treated with FP or budesonide for ≥ 6 months underwent a low-dose adrenocorticotropin stimulation test. Patients using systemic, inhaled, intranasal, or topical glucocorticoids were excluded. The primary outcome is AI, defined as peak serum cortisol <18 μg/dL (≤ 495 nmol/L).
  
  
  RESULTS
  Of 58 patients (81% male), 67% were on FP (median age 13.7 years [range 4.3-19.1], dose 1320 μg/d [440-1760], treatment duration 4.0 years [0.6-13.5]). Thirty-three percent were on budesonide (median age 10.7 years [range 3.2-17.2], dose 1000 μg/d [500-2000], treatment duration 3.4 years [0.6-7.7]). The overall prevalence of abnormal peak cortisol response (≤ 20 μg/dL) was 15% (95% CI 6%-25%) (indeterminate [18-20 μg/dL] 5% [n = 3] vs AI [<18 μg/dL] 10% [n = 6]). All patients on budesonide had a normal response vs only 77% of patients on FP (P = .02), all of whom were taking FP at a dose >440 μg/d.
  
  
  CONCLUSIONS
  AI was present in 10% of children treated with swallowed glucocorticoids for ≥ 6 months and was found only in those treated with FP >440 μg/d. We recommend low-dose adrenocorticotropin stimulation testing in children treated long term with high dose FP to allow early detection of AI.
authors.affiliation: Division of Pediatric Endocrinology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: joygolekoh@gmail.com.
authors.forename: Marjorie C
authors.initials: MC
authors.lastname: Golekoh
authors.affiliation: Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Lindsey N
authors.initials: LN
authors.lastname: Hornung
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Mukkada
authors.affiliation: Division of Pediatric Endocrinology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Biostatistics and Epidemiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Putnam
authors.affiliation: Division of Pediatric Endocrinology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Philippe F
authors.initials: PF
authors.lastname: Backeljauw
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019819:Budesonide / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D057765:Eosinophilic Esophagitis / Q000188:drug therapy*; D005260:Female; D000068298:Fluticasone / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide; D000068298:Fluticasone