Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate. (27th July 2010)

• Record Type: Journal Article
• Authors: Santiago Santiago, Angela H. Angela H.; Ratzan Ratzan, Susan Susan
• Other Names: Merke Merke Deborah Deborah Academic Editor.
• Is Part Of: International journal of pediatric endocrinology. Volume 2010(2010)
• Publication Date: 2010-07-27
• Subjects: Pediatric endocrinology -- Periodicals; Endocrine glands -- Diseases -- Periodicals; 618.924
• DOI: 10.1155/2010/749239
• Languages: English
• ISSNs: 1687-9856

Abstract

Abstract : Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 μ g/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.