University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Allergy Asthma Clin Immunol. 2011 Aug 25;7(1):13. doi: 10.1186/1710-1492-7-13.
Inhaled corticosteroids (ICSs) are the most effective anti-inflammatory agents available for the treatment of asthma and represent the mainstay of therapy for most patients with the disease. Although these medications are considered safe at low-to-moderate doses, safety concerns with prolonged use of high ICS doses remain; among these concerns is the risk of adrenal suppression (AS). AS is a condition characterized by the inability to produce adequate amounts of the glucocorticoid, cortisol, which is critical during periods of physiological stress. It is a proven, yet under-recognized, complication of most forms of glucocorticoid therapy that can persist for up to 1 year after cessation of corticosteroid treatment. If left unnoticed, AS can lead to significant morbidity and even mortality. More than 60 recent cases of AS have been described in the literature and almost all cases have involved children being treated with ≥500 μg/day of fluticasone.The risk for AS can be minimized through increased awareness and early recognition of at-risk patients, regular patient follow-up to ensure that the lowest effective ICS doses are being utilized to control asthma symptoms, and by choosing an ICS medication with minimal adrenal effects. Screening for AS should be considered in any child with symptoms of AS, children using high ICS doses, or those with a history of prolonged oral corticosteroid use. Cases of AS should be managed in consultation with a pediatric endocrinologist whenever possible. In patients with proven AS, stress steroid dosing during times of illness or surgery is needed to simulate the protective endogenous elevations in cortisol levels that occur with physiological stress.This article provides an overview of current literature on AS as well as practical recommendations for the prevention, screening and management of this serious complication of ICS therapy.
吸入性皮质类固醇（ICS）是目前治疗哮喘最有效的抗炎药，也是大多数哮喘患者的主要治疗方法。尽管这些药物在低至中等剂量下被认为是安全的，但长期使用高剂量 ICS 的安全性问题仍然存在；其中包括肾上腺抑制（AS）的风险。AS 是一种特征为无法产生足够量的糖皮质激素皮质醇的疾病，而皮质醇在生理应激期间是至关重要的。它是大多数形式的糖皮质激素治疗的一种已被证实但仍未被充分认识的并发症，可以在停止皮质类固醇治疗后持续长达 1 年。如果未被发现，AS 可能导致严重的发病率，甚至死亡率。在文献中已经描述了超过 60 例最近的 AS 病例，几乎所有病例都涉及使用 ≥500μg/天氟替卡松治疗的儿童。通过提高对高危患者的认识和早期识别、定期随访以确保使用最低有效 ICS 剂量控制哮喘症状以及选择具有最小肾上腺作用的 ICS 药物，可以最大限度地降低 AS 的风险。应该考虑对有 AS 症状、使用高 ICS 剂量或有长期口服皮质类固醇使用史的任何儿童进行 AS 筛查。只要可能，应在儿科内分泌学家的咨询下管理 AS 病例。在已确诊患有 AS 的患者中，需要在患病或手术期间进行应激类固醇剂量治疗，以模拟生理应激时皮质醇水平的内源性升高，这是一种保护作用。本文提供了关于 AS 的当前文献综述，以及预防、筛查和管理 ICS 治疗严重并发症的实用建议。
