Albert S G, Slavin R G
St. Louis University Health Sciences Center, Division of Endocrinology and Metabolism, Missouri 63104, USA.
Ann Allergy Asthma Immunol. 1998 Dec;81(6):582-4. doi: 10.1016/S1081-1206(10)62709-3.
Whereas oral corticosteroids and high-dose inhaled corticosteroids may be associated with suppression of the hypothalamic-pituitary-adrenal axis, medium-dose inhaled corticosteroids have not been reported to be associated with clinically significant adrenal insufficiency in the adult.
A case study of adrenal responsiveness after prolonged medium-dose inhaled corticosteroids and after replacement of steroid therapy by inhaled nedocromil sodium is described.
Standard 250-microg dose ACTH (cosyntropin) stimulation tests were followed after replacement of inhaled triamcinolone acetonide therapy by nedocromil sodium.
A 55-year-old woman who had been on inhaled triamcinolone acetonide, 1600 microg/day for 12 years, presented with symptoms of adrenal hypofunction upon inhaled corticosteroid taper. An ACTH stimulation test confirmed adrenal insufficiency. She was switched to inhaled nedocromil sodium with improvement in her clinical syndrome and normalization of her ACTH stimulation test.
Withdrawal from prolonged use of inhaled medium-dose corticosteroids may be associated with clinically significant adrenal insufficiency in adults. Steroid sparing agents may be considered for those on long-term inhaled corticosteroid therapy.
口服皮质类固醇和高剂量吸入性皮质类固醇可能与下丘脑 - 垂体 - 肾上腺轴的抑制有关，而中剂量吸入性皮质类固醇在成人中尚未被报道与具有临床意义的肾上腺功能不全相关。
描述了一例长期使用中剂量吸入性皮质类固醇后以及用吸入性奈多罗米钠替代类固醇治疗后的肾上腺反应性的病例研究。
在用奈多罗米钠替代吸入性曲安奈德治疗后，进行标准的250微克剂量促肾上腺皮质激素（考的松）刺激试验。
一名55岁女性，每天吸入1600微克曲安奈德，持续12年，在减少吸入性皮质类固醇用量时出现肾上腺功能减退症状。促肾上腺皮质激素刺激试验证实肾上腺功能不全。她改用吸入性奈多罗米钠后，临床综合征改善，促肾上腺皮质激素刺激试验恢复正常。
长期使用吸入性中剂量皮质类固醇后停药可能与成人临床上显著的肾上腺功能不全有关。对于长期接受吸入性皮质类固醇治疗的患者，可考虑使用类固醇节省剂。
