Adrenal Insufficiency after Chronic Swallowed Glucocorticoid Therapy for Eosinophilic Esophagitis - 25/02/16
, Lindsey N. Hornung, MS 2, Vincent A. Mukkada, MD 3, Jane C. Khoury, PhD 1, 2, Philip E. Putnam, MD 3, Philippe F. Backeljauw, MD 1Abstract |
Objective |
To establish the prevalence of adrenal insufficiency (AI) in children with eosinophilic esophagitis treated with swallowed fluticasone propionate (FP) or budesonide.
Study design |
Children treated with FP or budesonide for ≥6 months underwent a low-dose adrenocorticotropin stimulation test. Patients using systemic, inhaled, intranasal, or topical glucocorticoids were excluded. The primary outcome is AI, defined as peak serum cortisol <18 μg/dL (≤495 nmol/L).
Results |
Of 58 patients (81% male), 67% were on FP (median age 13.7 years [range 4.3-19.1], dose 1320 μg/d [440-1760], treatment duration 4.0 years [0.6-13.5]). Thirty-three percent were on budesonide (median age 10.7 years [range 3.2-17.2], dose 1000 μg/d [500-2000], treatment duration 3.4 years [0.6-7.7]). The overall prevalence of abnormal peak cortisol response (≤20 μg/dL) was 15% (95% CI 6%-25%) (indeterminate [18-20 μg/dL] 5% [n = 3] vs AI [<18 μg/dL] 10% [n = 6]). All patients on budesonide had a normal response vs only 77% of patients on FP (P = .02), all of whom were taking FP at a dose >440 μg/d.
Conclusions |
AI was present in 10% of children treated with swallowed glucocorticoids for ≥6 months and was found only in those treated with FP >440 μg/d. We recommend low-dose adrenocorticotropin stimulation testing in children treated long term with high dose FP to allow early detection of AI.
Le texte complet de cet article est disponible en PDF.Keyword : ACTH, AI, BMI, EoE, FP, H-P-A, LDST
Plan
| Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; 8 UL1 TR000077). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no conflicts of interest. |
Vol 170
P. 240-245 - mars 2016 Retour au numéro
Article précédent
- Neurodevelopmental Outcome and Treatment Efficacy of Benzoate and Dextromethorphan in Siblings with Attenuated Nonketotic Hyperglycinemia
- Kendra J. Bjoraker, Michael A. Swanson, Curtis R. Coughlin, John Christodoulou, Ee S. Tan, Mark Fergeson, Sarah Dyack, Ayesha Ahmad, Marisa W. Friederich, Elaine B. Spector, Geralyn Creadon-Swindell, M. Antoinette Hodge, Sommer Gaughan, Casey Burns, Johan L.K. Van Hove
- The Geographic Impact on Hospitalization in Patients with Cystic Fibrosis
- Benjamin T. Kopp, Lisa Nicholson, Grace Paul, Joseph Tobias, Chandar Ramanathan, Don Hayes
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?