Hollman G A, Allen D B
Department of Pediatrics, University of Wisconsin, School of Medicine, Madison.
Pediatrics. 1988 Mar;81(3):452-5.
Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticosteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.
吸入性糖皮质激素已成为治疗儿童哮喘的重要治疗选择。目前可供儿科使用的制剂（二丙酸倍氯米松和曲安奈德）一般不会引起明显的下丘脑 - 垂体 - 肾上腺轴抑制，使用这些制剂时也未出现糖皮质激素过量的体征。我们报告了一名8岁哮喘女童，在单独使用吸入性曲安奈德治疗期间出现肥胖、多毛症和生长发育迟缓。实验室检查显示内源性皮质醇分泌受抑制，但未证实下丘脑 - 垂体 - 肾上腺轴受抑制。停用吸入性曲安奈德治疗后，肥胖和多毛症得到缓解，生长恢复正常，血清皮质醇水平和尿17 - 羟皮质类固醇排泄恢复正常。对使用吸入性糖皮质激素的哮喘儿童仔细监测生长速度以及（如有临床指征）监测清晨血清皮质醇水平，将能发现这些药物全身吸收导致糖皮质激素过量的罕见情况。
