Santiago Angela H, Ratzan Susan
Division of Pediatric Endocrinology, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT 06106, USA.
Int J Pediatr Endocrinol. 2010;2010. doi: 10.1155/2010/749239. Epub 2010 Aug 11.
Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 mug/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.
长期使用吸入性糖皮质激素继发的肾上腺抑制通常仅限于生化异常，无明显临床效应。急性肾上腺危象是更为罕见的事件，但报告的频率在增加。我们报告一例7岁哮喘儿童，在呼吸道感染后出现嗜睡的急性病史。他多年来一直每日使用220微克丙酸氟替卡松。初始评估显示严重肾上腺抑制，皮质醇水平检测不到，促肾上腺皮质激素刺激后反应极小。停用氟替卡松后，肾上腺轴逐渐恢复。该病例表明，即使是常用的处方剂量也可能导致急性肾上腺危象，强调了使用控制症状所需的最低吸入性类固醇剂量以及提高对该并发症认识的重要性。
