Rao Bondugulapati L N, Rees D A
Wrexham Maelor Hospital, Wrexham, UK.
Neurosciences and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK.
Clin Endocrinol (Oxf). 2016 Aug;85(2):165-9. doi: 10.1111/cen.13073. Epub 2016 Apr 28.
Inhaled corticosteroids (ICS) are established as a cornerstone of management for patients with bronchoconstrictive lung disease. However, systemic absorption may lead to suppression of the hypothalamic-pituitary-adrenal (HPA) axis in a significant minority of patients. This is more likely in 'higher risk' patients exposed to high cumulative ICS doses, and in those treated with frequent oral corticosteroids or drugs which inhibit cytochrome p450 3A4. Hypothalamic-pituitary-adrenal axis suppression is frequently unrecognized, such that some patients, notably children, only come to light when an adrenal crisis is precipitated by physical stress. To minimize this risk, 'higher risk' patients and those with previously identified suppressed cortisol responses to Synacthen testing should undergo an education programme to inform them about sick day rules. A review of ICS therapy should also be undertaken to ensure that the dose administered is the minimum required to control symptoms.
吸入性糖皮质激素（ICS）已被确立为支气管收缩性肺病患者管理的基石。然而，全身吸收可能导致相当一部分患者的下丘脑-垂体-肾上腺（HPA）轴受到抑制。在接触高累积ICS剂量的“高风险”患者以及接受频繁口服糖皮质激素或抑制细胞色素P450 3A4的药物治疗的患者中，这种情况更有可能发生。下丘脑-垂体-肾上腺轴抑制常常未被识别，以至于一些患者，尤其是儿童，只有在身体应激引发肾上腺危象时才被发现。为了将这种风险降至最低，“高风险”患者以及先前已确定对辛纳克试验的皮质醇反应受到抑制的患者应接受教育计划，告知他们患病日规则。还应审查ICS治疗，以确保所给予的剂量是控制症状所需的最小剂量。
