Corticosteroids
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Acute adrenal insufficiency with hypoglycaemic seizures in a neonate following in utero exposure: case report Acute adrenal insufficiency with hypoglycaemic seizures occurred in a male neonate after in utero exposure to prednisone, salmeterol/fluticasone propionate and beclometasone. The boy’s 28-year-old mother had a history of ChurgStrauss syndrome, and received daily oral prednisone 11mg, inhaled salmeterol/fluticasone propionate 50µg/1000µg and nasal beclometasone 200µg throughout pregnancy. The 3.2kg neonate was delivered vaginally, with Apgar scores of 10 and 10, and exhibited hypospadias and angioma simplex on birth. He developed seizures requiring ICU admission on day 2; at that time, he had a body temperature of 35°C, a HR of 105/min and undetectable capillary blood glucose levels. The neonate received glucose, and his capillary blood glucose level rapidly increased to 59 mg/dL. He had a low basal cortisol level of 0.9 µg/dL and a GH level of 35 mU/L on day 5, and laboratory investigations on day 14 showed testosterone, FSH and LH levels of 435 ng/dL, 5.4 UL/L [sic] and 7.5 U/L, respectively. Arterial blood gas analysis, ultrasound, MRI and EEG were normal. Early-onset neonatal cortico-induced adrenal insufficiency was diagnosed, and he started receiving hydrocortisone. He underwent an ACTH stimulation test on day 23, and his cortisol level subsequently increased, reaching 12.9 µg/dL on day 40. Hydrocortisone was gradually withdrawn by day 37. The neonate remained asymptomatic on day 45 of follow-up, with a normal basal plasma cortisol level. He later underwent surgical correction of hypospadias without clinical or biological relapse. Author comment: "The French method of Begaud et al. was used to assess the possible causal relationship between [acute adrenal insufficiency] and drugs: This suggested that an intrinsic causality for prednisone was plausible. The involvement of the other medications to which the boy had been exposed . . . was not excluded, but the causality score was lower." Saulnier P-J, et al. Hypoglycaemic seizure and neonatal acute adrenal insufficiency after maternal exposure to prednisone during pregnancy: A case report. European Journal of Pediatrics 169: 763-765, No. 6, Jun 2010. Available from: URL: http:// 803022192 dx.doi.org/10.1007/s00431-009-1095-9 - France
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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of hypoglycaemic seizures associated with prednisone.
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Reactions 26 Jun 2010 No. 1307
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