Phoenix Children's Hospital, Phoenix, Arizona.
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis.
JAMA Pediatr. 2016 Feb;170(2):163-70. doi: 10.1001/jamapediatrics.2015.3526.
Inhaled corticosteroids (ICSs) are widely used as first-line treatment for various chronic respiratory illnesses. Advances in devices and formulations have reduced their local adverse effects. However, as delivery of ICSs to the lungs improves, the systemic absorption increases, and an adverse effect profile similar to, although milder than, oral corticosteroids has emerged. The most serious potential adverse effect is adrenal insufficiency, which can be life threatening. Adrenal insufficiency occurs most in patients taking the highest doses of ICSs but is reported with moderate or even low doses as well. Our recommendations include greater vigilance in testing adrenal function than current standard practice. In patients with diabetes mellitus (types 1 and 2), an increase in glucose levels is likely, and diabetes medication adjustment may be needed when initiating or increasing ICSs. The risk of linear growth attenuation and adverse effects on bone mineral density is generally low but should be considered in the face of additional risk factors. On behalf of the Pediatric Endocrine Society Drugs and Therapeutics Committee, we present a review of the endocrine adverse effects of ICSs in children and offer recommendations relating to testing and referral. Limited data in particular realms diminish the strength of certain recommendations, and clinical judgment continues to be paramount.
吸入性皮质类固醇（ICSs）被广泛用作各种慢性呼吸道疾病的一线治疗药物。器械和配方的进步减少了它们的局部不良反应。然而，随着 ICSs 向肺部的输送改善，全身吸收增加，并且出现了与口服皮质类固醇相似（尽管较轻）的不良反应谱。最严重的潜在不良反应是肾上腺功能不全，这可能危及生命。肾上腺功能不全在服用最高剂量 ICSs 的患者中最常见，但也有报道称中等甚至低剂量也会出现。我们的建议包括比目前的标准实践更密切地监测肾上腺功能。在糖尿病患者（1 型和 2 型）中，血糖水平可能会升高，在开始或增加 ICSs 时可能需要调整糖尿病药物。线性生长衰减和对骨矿物质密度的不良影响的风险通常较低，但在存在其他危险因素的情况下应予以考虑。代表儿科内分泌学会药物和治疗委员会，我们对儿童 ICSs 的内分泌不良反应进行了综述，并提出了与检测和转介相关的建议。特定领域的有限数据降低了某些建议的强度，临床判断仍然至关重要。
