Adrenal Insufficiency from Inhaled Corticosteroids
Authors: Andrew White, Donald P. Woodmansee
Journal: Annals of Internal Medicine (2004)

Letters16 March 2004Adrenal Insufficiency from Inhaled CorticosteroidsAndrew White, MD and Donald P. Woodmansee, MDAndrew White, MDFrom Scripps Clinic, La Jolla, CA 92037, and Naval Medical Center San Diego, San Diego, CA 92106. and Donald P. Woodmansee, MDFrom Scripps Clinic, La Jolla, CA 92037, and Naval Medical Center San Diego, San Diego, CA 92106.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-6-200403160-00034-w2 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: Inhaled corticosteroids are the mainstay of therapy for persistent asthma and are quite safe. Recently, however, studies have demonstrated that these agents can be absorbed systemically, as measured by effects on the hypothalamic–pituitary–adrenal axis and bone mineral density (1, 2). Very few patients experience adverse clinical events from this systemic absorption, and this phenomenon has been reported mainly in children (3, 4).Objective: To point out a rare but potentially serious side effect of inhaled steroids, we present a case of adrenal insufficiency in an adult secondary to high-dose inhaled fluticasone propionate.Case Report: A 47-year-old ...References1. Derom E, Van Schoor J, Verhaeghe W, Vincken W, Pauwels R. Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma. Am J Respir Crit Care Med. 1999;160:157-61. [PMID: 10390394] CrossrefMedlineGoogle Scholar2. Wong CA, Walsh LJ, Smith CJ, Wisniewski AF, Lewis SA, Hubbard R, et al . Inhaled corticosteroid use and bone-mineral density in patients with asthma. Lancet. 2000;355:1399-403. [PMID: 10791523] CrossrefMedlineGoogle Scholar3. Todd GR, Acerini CL, Buck JJ, Murphy NP, Ross-Russell R, Warner JT, et al . Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate. Eur Respir J. 2002;19:1207-9. [PMID: 12108877] CrossrefMedlineGoogle Scholar4. Todd GR, Wright D, Ryan M. Acute adrenal insufficiency in a patient with asthma after changing from fluticasone propionate to budesonide. J Allergy Clin Immunol. 1999;103:956-7. [PMID: 10329837] CrossrefMedlineGoogle Scholar5. Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch Intern Med. 1999;159:941-55. [PMID: 10326936] CrossrefMedlineGoogle Scholar6. National Asthma Education and Prevention Program.. Expert Panel Report: Guidelines for the diagnosis and management of asthma. Update on selected topics—2002. J Allergy Clin Immunol. 2002;110:S210-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Scripps Clinic, La Jolla, CA 92037, and Naval Medical Center San Diego, San Diego, CA 92106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoInhaled Corticosteroids and Adrenal Function Jacques Romney Inhaled Corticosteroids and Adrenal Function Andrew White and Donald P. Woodmansee Metrics Cited byModerate Dose Inhaled Corticosteroid-Induced Symptomatic Adrenal SuppressionLes actualités de l'insuffisance surrénalienneCushing Syndrome Caused by Topical Corticosteroid: A Case ReportEvaluation of pituitary function in the fatigued patient: a review of 59 casesExogenous Cushing's Syndrome and Glucocorticoid WithdrawalPerindopril and Pulmonary Eosinophilic SyndromeInhaled Corticosteroids and Adrenal FunctionJacques Romney, MD 16 March 2004Volume 140, Issue 6Page: W-27KeywordsAsthmaCortisolForced expiratory volume in the first second of expirationHospitalizationsMusclesPropionatesSafetySpirometrySteroidsVital signs ePublished: 16 March 2004 Issue Published: 16 March 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...