BMJ 2002;324:1081-1083 ( 4 May )

Clinical review

Lesson of the week
    Symptomatic adrenal insufficiency presenting with hypoglycaemia in children with asthma receiving high dose inhaled fluticasone propionate
    Commentary: Exogenous glucocorticoids influence adrenal function, but assessment can be difficult

Symptomatic adrenal insufficiency presenting with hypoglycaemia in asthmatic children with asthma receiving high dose inhaled fluticasone propionate

Children taking high dose fluticasone propionate may present with hypoglycaemia secondary to iatrogenic adrenal suppression

A J Drake, specialist registrar in paediatric endocrinology ^a, R J Howells, specialist registrar in paediatrics ^b, J P H Shield, consultant senior lecturer ^a, A Prendiville, consultant paediatrician ^c, P S Ward, consultant paediatrician ^d, E C Crowne, consultant paediatric endocrinologist and diabetologist ^a. 

^a Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol BS2 8BJ, ^b Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, ^c Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, ^d Derriford Hospital, Plymouth PL6 8DH

Correspondence to: E C Crowne eccrowne@bch.u-net.com

The first 150 words of the full text of this article appear below.

Inhaled corticosteroids are central to the successful long term management of asthma and are generally regarded as safe.¹ Systemic adverse effects have been described in children but are thought to be rare.² High dose inhaled corticosteroids are used in the step-up phase of treatment to optimise the control of asthma. Fluticasone propionate may be prescribed at higher doses to relieve respiratory symptoms in the belief that it generates fewer side effects than other inhaled steroids. Some studies have shown that fluticasone is safer than beclomethasone or budesonide, with limited oral absorption and extensive hepatic first pass metabolism leading to a lower systemic bioavailability.³ Others have shown that appreciable amounts of inhaled fluticasone are absorbed from the lung⁴; fluticasone has also been associated with growth retardation and adrenal suppression in children.⁵ Reports of adrenal insufficiency in childhood secondary to inhaled steroids have not described hypoglycaemia as a presenting feature.^5-7 We . . . [Full text of this article]

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