fluticasone and Hypoglycemia

Inhaled corticosteroids are a well established and effective treatment for asthma in children. However, some children develop systemic side effects including adrenal suppression when using moderate to high doses. Over the last few years, several severe acute adrenal crises with hypoglycaemia in patients using inhaled corticosteroids have been reported. Normally these patients do not develop a Cushingoid appearance and their height is not necessarily affected. We present a three-years-old boy that was unconscious at admittance. From the age of 6 months he had had asthma, treated with fluticasone propionate. The last year his asthma had been difficult to control, and he was given 750-1000 g/day in combination with salmeterol and a leucotriene antagonist. The day before admittance he had been ill with fever, had poor intake of food, and no intake of his regular medication. He was found unconscious in the morning. At admittance the blood glucose was 1.8. His cortisol axis was partially suppressed, probably as a result of the high doses of fluticasone propionate that had been administered. When treating asthmatic children it is important to use the lowest possible dose of inhaled corticosteroids. Those in need of higher doses should be carefully followed up with respect to systemic side effects. In emergency situations, systemic steroids should be used liberally in these children.

Topics: Administration, Inhalation; Albuterol; Androstadienes; Asthma; Bronchodilator Agents; Child, Preschool; Drug Therapy, Combination; Fluticasone; Humans; Hypoglycemia; Male; Salmeterol Xinafoate

Topics: Administration, Inhalation; Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Asthma; Fluticasone; Glucocorticoids; Growth; Humans; Hypoglycemia; Practice Patterns, Physicians'

Topics: Acute Disease; Administration, Inhalation; Administration, Topical; Adrenal Insufficiency; Androstadienes; Anti-Inflammatory Agents; Asthma; Child; Child, Preschool; Drug Administration Schedule; Fluticasone; Glucocorticoids; Humans; Hypoglycemia

Topics: Administration, Inhalation; Administration, Topical; Adrenal Insufficiency; Androstadienes; Anti-Inflammatory Agents; Asthma; Child; Fluticasone; Glucocorticoids; Humans; Hypoglycemia

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.. 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.. 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 microg/day). This child presented in adrenal crisis, as evidenced by severe hypoglycemia and seizures, I day after receiving the influenza vaccine. After hydrocortisone replacement and a long taper of fluticasone, the child's adrenal function returned to normal.. 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 microg/dL; after adrenocorticotrophic hormone stimulation, 8.4 microg/dL). Repeat evaluation 3 weeks after discontinuation of all corticosteroid therapy demonstrated normal HPA axis function.. 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.

Topics: Administration, Inhalation; Androstadienes; Anti-Allergic Agents; Child, Preschool; Female; Fluticasone; Glucocorticoids; Humans; Hydrocortisone; Hypoglycemia; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Seizures; Treatment Outcome