PEDIATRICS Vol. 81 No. 3 March 1988, pp. 452-455
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Overt Glucocorticoid Excess Due to Inhaled Corticosteroid Therapy

Gregory A. Hollman MD1 and David B. Allen MD1

1 From the Department of Pediatrics, University of Wisconsin, School of Medicine, Madison

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 corticorsteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.

Key Words: asthma • beclomethasone • inhaled corticosteroid • triamcinolone acetonide

Submitted on February 9, 1987
Accepted on May 4, 1987




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