alexa Adrenal Insufficiency after Chronic Swallowed Glucocorticoid Therapy for Eosinophilic Esophagitis.


Journal of Hepatology and Gastrointestinal disorders

Author(s): Golekoh MC, Hornung LN, Mukkada VA, Khoury JC, Putnam PE,

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Abstract 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. Copyright © 2016 Elsevier Inc. All rights reserved. This article was published in J Pediatr and referenced in Journal of Hepatology and Gastrointestinal disorders

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