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. 2004 Nov;89(11):1055–1058. doi: 10.1136/adc.2002.020560

Decreased cortisol response to insulin induced hypoglycaemia in asthmatics treated with inhaled fluticasone propionate

P Mahachoklertwatta 1, K Sudkronrayudh 1, C Direkwattanachai 1, L Choubtum 1, C Okascharoen 1
PMCID: PMC1719701  PMID: 15499064

Abstract

Aims: To assess adrenal function in asthmatic children treated with inhaled fluticasone propionate for up to 16 weeks.

Methods: Children with asthma and bronchial hyperresponsiveness to inhaled methacholine were treated with inhaled fluticasone 250–750 µg/day via Volumatic spacer. The insulin tolerance test (ITT) was performed to assess adrenal function.

Results: Eighteen asthmatic patients (10 boys, 8 girls), aged 7–17 years received inhaled fluticasone therapy at a median dose of 477 µg/m2 per day for 5–16 weeks. Adrenal suppression, defined as 60 minute serum cortisol less than 500 nmol/l, was found in 9 of 18 children. Following the ITT, the median basal and 60 minute serum cortisol concentrations of the suppressed group were 135.0 and 350.0 nmol/l, respectively; the corresponding values for the unsuppressed group were 242.2 and 564.7 nmol/l. Repeat ITT in the suppressed group 2–3 months after discontinuation of fluticasone revealed that all patients had a 60 minute serum cortisol greater than 500 nmol/l.

Conclusion: After therapy for asthma with inhaled fluticasone at approximately 500 µg daily for up to 16 weeks, half the children had evidence of adrenal suppression.

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Figure 1.

Figure 1

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 Median values of basal and 60 minute serum cortisol during an insulin tolerance test in asthmatic children according to adrenal suppression; 60 minute cortisol ⩽ 500 nmol/l indicates adrenal suppression.

Selected References

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