Fluticasone propionate overdose
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Hypercorticism and adrenal insufficiency in a child following inhalation: case report A 12-year-old girl developed hypercorticism and adrenal insufficiency following an overdose of inhaled fluticasone propionate for asthma [duration of treatment to reaction onset not clearly stated]. The girl, who had been receiving inhaled fluticasone propionate 500µg twice daily for 18 months along with a βadrenergic receptor agonist, reported persistent cough along with fatigue, mental instability, nausea and inner restlessness during regular check-ups despite a normal lung function and peak flow; she had previously experienced inadequate control of asthma symptoms despite high dose of inhaled corticosteroids (ICS). A reduction in her ICS dose had been recommended several times previously, but each time her family reported a decrease in peak flow and an exacerbation of her cough, which was attributed to her asthma. Gradually, her appearance became Cushingoid and her growth rate decreased to 1cm in a year; her bone age had decreased by 1.5 years. Due to the discrepancy between the girl’s symptoms and her clinical results, fluticasone propionate was replaced by budesonide/formoterol. A synacthen test revealed severe adrenal insufficiency. Her 24-hour urinary cortisol elimination was 0 nmol/L, adrenocorticotrophic hormone level was 3 ng/mL and glycosylated haemoglobin level was 0.050. Her symptoms were attributed to chronic bronchitis due to local immunoparesis triggered by the high corticosteroid dose. Her condition was compatible with iatrogenic hypercorticism. Following budesonide/formoterol initiation, she also received prednisolone for a fever-related stress episode, with good effects. Subsequently, she developed signs of continued adrenal insufficiency and received 2 weeks of substitution treatment with good effects. After gradual reduction in budesonide dose, her lung function remained normal , with improvement in other symptoms. Hypothalamus-hypophysisadrenal axis response normalised in 2 years. Bjerre JV, et al. Adrenal insufficiency during inhaled corticosteroid treatment in a child with asthma. Ugeskrift for Laeger 170: 2161, No. 24, 9 Jun 2008 [Danish: 801111793 summarised from a translation] - Denmark
0114-9954/10/1210-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 12 Jul 2008 No. 1210
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