Inhaled corticosteroids and secondary adrenal insufficiency.
Inhaled corticosteroids and secondary adrenal insufficiency.
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DOI：
10.2174/1874306401408010093
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Jalleh R
中科院分区：
文献类型：
--
作者：
Sannarangappa V;Jalleh R
吸入性皮质类固醇（ICS）已被用作哮喘的一线治疗数十年。ICS是一种外源性糖皮质激素，可以抑制内源性糖皮质激素的产生，这种情况称为肾上腺抑制（AS）。因此，停止、减少剂量或改变ICS的类型可能会触发肾上腺功能不全（AI）的特征。AI可能会引起一系列表现，从模糊的疲劳症状到可能危及生命的急性肾上腺危象。本文回顾了当前关于ICS和AI的文献，特别是在成人中（尽管大多数可用数据来自儿科人群）。它旨在提高对与ICS使用相关的AI潜在风险的认识，描述AI的发病机制，并提供有关筛查和管理的建议。从我们的文献综述中，我们发现许多病例报告显示ICS和AI之间存在关联，特别是在儿童和使用高剂量的患者中。然而，也有成人以及使用低至中等剂量ICS的患者中AI的报告。总之，我们建议在选定的患者组中筛查AI，并在清晨开始检测血清皮质醇。如果结果是异常的，更明确的测试，如低剂量促肾上腺皮质激素刺激试验可以做，以确认诊断。
Inhaled corticosteroids (ICS) have been used as first line treatment of asthma for many decades. ICS are a form of exogenous glucocorticosteroids that can suppress the endogenous production of glucocorticosteroids, a condition known as adrenal suppression (AS). As a result, cessation, decreasing the dose or changing the type of ICS may trigger features of adrenal insufficiency (AI). AI may cause a spectrum of presentations varying from vague symptoms of fatigue to potentially life threatening acute adrenal crises. This article reviews the current literature on ICS and AI particularly in adults (although majority of data available is from the paediatric population). It aims to increase awareness of the potential risk of AI associated with ICS use, delineate the pathogenesis of AI and to provide recommendations on screening and management. From our literature review, we have found numerous case reports that have shown an association between ICS and AI particularly in children and patients using high doses. However, there have also been reports of AI in adults as well as in patients using low to moderate doses of ICS. To conclude, we recommend screening for AI in select patient groups with an initial early morning serum cortisol. If results are abnormal, more definitive testing such as the low dose corticotropin stimulation test may be done to confirm the diagnosis.