Symptomatic adrenal insufficiency during inhaled corticosteroid treatment

Patel, Leena; Wales, J.; Kibirige, M S; Massarano, Albert; Couriel, Jon; Clayton, Peter E.

doi:10.1136/adc.85.4.330

Cited by 120 publications

(76 citation statements)

References 30 publications

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“…The latter probably explains symptomatic adrenal insufficiency in children even on moderate doses of ICS [8]. Moreover, there are case reports of iatrogenic Cushing's syndrome in children even on conventional doses of ICS [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…The data from the current study of adrenal suppression in 20.8% of asthmatic children on mild and moderate doses of budesonide are in general agreement with the literature. The present authors do not know whether these children would present symptomatic adrenal insufficiency if they were treated with much larger doses of budesonide, such as children on large doses of fluticasone who reportedly experienced adrenal crisis [7][8][9][25][26][27]]. …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, a number of studies reported growth retardation and/or mild adrenal suppression in asthmatic children treated with ICS [3][4][5][6]. Recently, there were reports of symptomatic adrenal insufficiency in children on chronic ICS treatment [7][8][9]. The vast majority of these children were treated with high doses of inhaled fluticasone.…”

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confidence: 99%

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The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

Priftis

Papadimitriou²,

Gatsopoulou³

et al. 2006

European Respiratory Journal

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The present authors evaluated adrenal reserve in asthmatic children on long-term inhaled corticosteroids and whether possible adrenal suppression could be predicted by growth retardation.Low-dose synacthen test (0. . The current authors calculated height standard deviation score (HSDS) at the time of testing and height velocity SDS (HVSDS) in the preceding year.Mean HSDS was 0.06¡1.3 and HVSDS was -0.9¡2.3. Adrenal suppression was disclosed in 15 asthmatic children (20.8%). There were no differences in HSDS and HVSDS between children with and without adrenal suppression. There was no correlation between peak cortisol response and dose or duration of treatment. However, a positive relationship between HVSDS and duration of treatment was noted.These data suggest that long-term treatment of asthmatic children with low and moderate doses of inhaled budesonide may result in mild adrenal suppression that cannot be predicted by growth deceleration. The negative influence of inhaled corticosteroids on growth becomes less the longer the duration of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

Priftis

Papadimitriou²,

Gatsopoulou³

et al. 2006

European Respiratory Journal

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“…Corticosteroid withdrawal could cause hypoglycemia and it was anecdotally reported that hypoglycemia can occur also during inhaled corticosteroid treatment (49). Only oral and not inhaled steroids were being administered in few (10) studies, which were performed at least 3 weeks from the last change in dosage.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hypoglycemia in patients with cystic fibrosis

Battezzati¹,

Battezzati²,

Costantini³

et al. 2007

eur j endocrinol

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Objective: Diabetes frequently complicates cystic fibrosis (CF) without fasting hyperglycemia or despite spontaneous hypoglycemia (anecdotally ascribed to malnutrition), whose prevalence, clinical meaning, and relationship with glucose tolerance and clinical/nutritional status were not previously investigated. The relationship of CF genotype with insulin secretion control is also unclear. Design and methods: A total of 129 CF patients without stable diabetes received 188 oral glucose tolerance tests. Distribution of fasting plasma glucose (FPG), glucose, insulin and C-peptide responses, clinical/nutritional variables, and their relationships were analyzed. Results: FPG!60 mg/dl (3.3 mmo/l) was detected in 14% of studies and reactive hypoglycemia (PG!50 mg/dl (2.8 mmo/l)) in 15%. OGTT-based diabetes frequency was similar in the lowest quartile (Q1) and Q2-3 for FPG (10 and 8%), with higher glucose increment and area under the curve in Q1. Insulin and C-peptide levels were similar among FPG quartiles. Class I cystic fibrosis transmembrane conductance regulator mutation carriers had higher insulin concentrations than class II, especially in Q1 for FPG. Age, sex, nutritional, and anthropometric parameters including fat and lean body mass were unrelated to FPG. Lower FPG was associated with more frequent hospitalization rates (PZ0.002) and lower Shwachman scores (PZ0.041). Steroids weaning was accurately evaluated but then excluded as a possible cause of hypoglycemia. Conclusions/interpretation: Fasting asymptomatic hypoglycemia is frequent and possibly related to inappropriate insulin secretion control in class I mutation carriers. Low FPG does not exclude impaired glucose tolerance (IGT) and diabetes in CF and reflects worse clinical status.

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“…oral corticosteroid Patel et al 2001 (30) Case series 4.5 to 10 years A higher than Hypoglycemia, little height gain, and limited of adrenal insufficiency (8 standard dose weight gain, together with altered serum cortisol, cases) treated with of an inhaled response to adrenocorticotropin stimulus inhaled corticosteroids corticosteroid and 24-h urinary cortisol metabolites was used in 1 case. Grebe et al 1997 (5) Controlled, observational 21 patients 4 to 8 years of 24-h urinary cortisol (p < 0.08), 1996 (29) paired 16+ years treatment with serum cortisol and tetracosactrin test beclomethasone were significantly (p < 0.05) lower than that of controls.…”

Section: Factors That Influence Systemic Absorptionmentioning

confidence: 99%

Corticóide inalatório: efeitos no crescimento e na supressão adrenal

et al. 2005

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This is a review of the medical literature regarding inhaled corticosteroids and their effects on growth and adrenal suppression in children and adolescents. A review of the literature, principally that published over the last five years, was conducted using Medline and searching indexes of articles published in national and international scientific journals. There is considerable controversy regarding the side effects of inhaled corticosteroids. In 21 studies evaluating the effect that inhaled corticosteroids have on growth, a statistically significant reduction (growth retarded by 1-1.5 cm) was observed within the first year of treatment with Beclomethasone or Budesonide inhalers. However, in studies of longer duration, no significant difference was found between final adult height and adult height of the parents. However, in ten studies of the use of inhaled corticosteroids and their effect on adrenal suppression, hypoglycemia and arrested development (no height or weight gains), as well as changes in morning serum levels and 24-h urinary levels of cortisol, were reported, especially when high doses of inhaled corticosteroids were used. Inhaled corticosteroids can reduce growth during the first year of use but do not affect adult height. However, further long-term studies are needed in order to determine the full impact of inhaled corticosteroids on final adult height. Height measures are a means of evaluating the safety and efficacy of the use of inhaled corticosteroids in children. Tests that evaluate the hypothalamic-pituitary-adrenal axis and adrenal insufficiency should be correlated with clinical symptoms and side effects.

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Symptomatic adrenal insufficiency during inhaled corticosteroid treatment

Cited by 120 publications

References 30 publications

The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

Spontaneous hypoglycemia in patients with cystic fibrosis

Corticóide inalatório: efeitos no crescimento e na supressão adrenal

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