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Cited by 341Adrenal Hormones and DisordersPharmacovigilance and Adverse Drug ReactionsStress Responses and Cortisol

Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom

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Todd, G R G·2002·Archives of Disease in Childhood
DOI 10.1136/adc.87.6.457PMC PMC1755820
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Abstract

BACKGROUND: Until recently, only two cases of acute adrenal crisis associated with inhaled corticosteroids (ICS) had been reported worldwide. We identified four additional cases and sought to survey the frequency of this side effect in the United Kingdom. METHODS: Questionnaires were sent to all consultant paediatricians and adult endocrinologists registered in a UK medical directory, asking whether they had encountered asthmatic patients with acute adrenal crisis associated with ICS. Those responding positively completed a more detailed questionnaire. Diagnosis was confirmed by symptoms/signs and abnormal hypothalamic-pituitary-adrenal axis function test results. RESULTS: From an initial 2912 questionnaires, 33 patients met the diagnostic criteria (28 children, five adults). Twenty-three children had acute hypoglycaemia (13 with decreased levels of consciousness or coma; nine with coma and convulsions; one with coma, convulsions and death); five had insidious onset of symptoms. Four adults had insidious onset of symptoms; one had hypoglycaemia and convulsions. Of the 33 patients treated with 500-2000 micro g/day ICS, 30 (91%) had received fluticasone, one (3%) fluticasone and budesonide, and two (6%) beclomethasone. CONCLUSIONS: The frequency of acute adrenal crisis was greater than expected as the majority of these patients were treated with ICS doses supported by British Guidelines on Asthma Management. Despite being the least prescribed and most recently introduced ICS, fluticasone was associated with 94% of the cases. We therefore advise that the licensed dosage of fluticasone for children, 400 micro g/day, should not be exceeded unless the patient is being supervised by a physician with experience in problematic asthma. We would also emphasise that until adrenal function has been assessed patients receiving high dose ICS should not have this therapy abruptly terminated as this could precipitate adrenal crisis.

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  • Unmasking of secondary adrenal insufficiency may occur in patients who are abruptly withdrawn from supraphysiologic doses of glucocorticoid, including oral and inhaled steroids.

    “Unmasking of SAI may occur in patients who are abruptly withdrawn from supraphysiologic doses of glucocorticoid, which includes not only oral but also inhaled steroids.36”

    From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [36]

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Research works printed but not linked: 29

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Authors
Todd, G. R. G.
Affiliations
Antrim Area Hospital (GB)
Corresponding author
Todd, G R G
Venue
Archives of Disease in Childhood
Publisher
BMJ
Published
2002-12-01
Volume
87
Issue
6
Pages
457-461
ISSN
  • 0003-9888 (ISSN-L)
  • 1468-2044
DOI
10.1136/adc.87.6.457
PMC
PMC1755820
OpenAlex
W1963763550
Cited by
341
References
0
Citations by year
2026: 4 · 2025: 2 · 2024: 9 · 2023: 2 · 2022: 9 · 2021: 11 · 2020: 13 · 2019: 14 · 2018: 9 · 2017: 8 · 2016: 12 · 2015: 9 · 2014: 16 · 2013: 6 · 2012: 16
FWCI
10.28
Type
journal article
Language
en
Open access
Locations
  • Archives of Disease in Childhood (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • AstraZeneca
  • Department of Health, Northern Ireland
  • Merck Sharp and Dohme
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
adrenal crisis, inhaled corticosteroids, fluticasone, asthma, hypoglycemia, hypothalamic-pituitary-adrenal axis, adrenal insufficiency, corticosteroid adverse effects, beclomethasone, budesonide, asthma guidelines
MeSH terms
Acute Disease, Administration, Inhalation, Adolescent, Adrenal Cortex Hormones, Adrenal Gland Diseases, Adult, Aged, Aged, 80 and over, Anthropometry, Asthma, Child, Child, Preschool, Female, United Kingdom, Humans, Hypoglycemia, Hypothalamo-Hypophyseal System, Male, Middle Aged, Severity of Illness Index, Health Care Surveys

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