Hypothalamic-pituitary-adrenal axis suppression associated with the use of inhaled fluticasone propionate☆,☆☆,★,★★
Section snippets
Case 1
A 12-year-old boy with mild asthma experienced an exacerbation requiring increased use of inhaled albuterol. No improvement resulted after 2 weeks of inhaled cromolyn sodium. He began receiving inhaled triamcinolone acetonide (400 μg twice daily) and oral prednisolone (22.5 mg twice daily for 5 days). Six weeks later, inhaled GCS was changed to FP (660 μg twice daily) by means of a spacer. After 4 months of treatment with FP, the patient had symptoms of increased thirst, acne, facial swelling,
DISCUSSION
Inhaled corticosteroids have previously been reported to cause Cushing syndrome in rare cases.1 Inhaled FP is considered to be a safe and effective medication with negligible side effects owing to its first pass metabolism by the liver, high topical potency, high affinity for the glucocorticoid receptor, and a long elimination half-life.2 In one clinical study in adults, fasting morning cortisol levels remained within the normal range during treatment with inhaled fluticasone at a dose of 2000
Acknowledgements
We thank Ms Tazim Verjee for manuscript preparation.
References (5)
- et al.
Effects of inhaled fluticasone propionate and oral prednisolone on lymphocyte β-2 adrenoreceptor function in asthmatic patients
Chest
(1996) - et al.
Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate
Lancet
(1996)
Cited by (29)
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From a the University of South Florida/All Children’s Hospital, St. Petersburg, and b Diagnostic Clinic, Clearwater.
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Reprint requests: Stephen J. Kornfeld, MD, Division of Allergy and Immunology, University of South Florida/All Children’s Hospital, 801 Sixth St South, St. Petersburg, FL 33701.
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J Allergy Clin Immunol 1998;102:699-700.
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