High levels of an inhaled drug used to treat asthma have been linked to adrenal gland failure in children, according to the results of a UK survey published in the December issue of the journal Archives of Disease in Childhood.
Researchers from several hospitals across the UK found that high doses of the inhaled corticosteroid (ICS) fluticasone was associated with adrenal gland malfunction leading to coma and convulsions, especially among children.
The team sent questionnaires to all consultant paediatricians and adult endocrinologists registered in a UK medical directory (n= almost 3000), asking if they had come across asthmatic patients with acute adrenal crisis associated with ICS.
Those responding positively were asked to complete a more in depth questionnaire. Diagnosis was confirmed by symptoms/signs and abnormal hypothalamic-pituitary-adrenal axis function test results.
The researchers analysed more than 700 returned questionnaires and it was found that 28 children and 5 adults had suffered “adrenal crisis” linked to high level of inhaled steroids prescribed for asthma. Twenty-three children had acute hypoglycaemia (13 with decreased levels of consciousness or coma; 9 with coma and convulsions; 1 with coma, convulsions and death); 5 had insidious onset of symptoms.
Four adults had insidious onset of symptoms; 1 had hypoglycaemia and convulsions. Of the 33 patients treated with 500-2000 mcg/day ICS, 30 (91%) had received fluticasone, one (3%) fluticasone and budesonide, and two (6%) beclomethasone
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