Impaired recovery of hypothalamic-pituitary-adrenal axis function and hypoglycemic seizures after high-dose inhaled corticosteroid therapy in a toddler
| Autor: | Rolando A. Lozano, Robert G. Castile, Mary Jayne Kennedy, Janice M. Carpenter |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Pulmonary and Respiratory Medicine
Hypothalamo-Hypophyseal System Hydrocortisone medicine.drug_class Immunology Pituitary-Adrenal System Hypoglycemia Seizures Administration Inhalation Anti-Allergic Agents Adrenal insufficiency Humans Immunology and Allergy Medicine Glucocorticoids Fluticasone Reactive airway disease business.industry Adrenal crisis medicine.disease Androstadienes Treatment Outcome medicine.anatomical_structure Child Preschool Anesthesia Corticosteroid Female medicine.symptom business Hypothalamic–pituitary–adrenal axis medicine.drug |
| Zdroj: | Annals of Allergy, Asthma & Immunology. 88:523-526 |
| ISSN: | 1081-1206 |
| DOI: | 10.1016/s1081-1206(10)62393-9 |
| Popis: | Background Corticosteroids are the treatment of choice for children with persistent reactive airway disease. In these patients, taper and discontinuation of systemic therapy is often facilitated by transition to high-dose inhaled corticosteroid treatment. Objective To report a case of impaired hypothalamic-pituitary-adrenal (HPA) axis recovery and adrenal crisis associated with prolonged high-dose inhaled therapy after long-term systemic corticosteroid treatment. Methods A 32-month-old child with severe airway obstruction and wheezing was treated with long-term daily systemic (intravenous and oral) corticosteroids followed by high-dose inhaled fluticasone (440 to 1,320 μg/day). This child presented in adrenal crisis, as evidenced by severe hypoglycemia and seizures, 1 day after receiving the influenza vaccine. After hydrocortisone replacement and a long taper of fluticasone, the child's adrenal function returned to normal. Results At the time of seizure, the serum glucose was 1 mg/dL. An electroencephalogram, computed tomographic scan, and magnetic resonance imaging of the brain were normal. Adrenal insufficiency was documented (morning serum cortisol, 0.6 μg/dL; after adrenocorticotrophic hormone stimulation, 8.4 μg/dL). Repeat evaluation 3 weeks after discontinuation of all corticosteroid therapy demonstrated normal HPA axis function. Conclusions After treatment with long-term systemic steroids, high-dose inhaled corticosteroid therapy can impair recovery of the HPA axis and place patients at risk for adrenal crisis. |
| Databáze: | OpenAIRE |
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