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[A three-year-old boy with hypoglycaemia]

Bernt Christian Hellerud1, Ole Bjørn Kittang, Per Vesterhus

  • 1Barnesenteret, Sørlandet Sykehus Kristiansand, 4604 Kristiansand. per.vesterhus@sshf.no

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|August 23, 2005
PubMed

Insights

High-dose inhaled corticosteroids can cause adrenal suppression in children with asthma. Careful monitoring and appropriate steroid use in emergencies are crucial for managing this risk.

Area of Science:

  • Pediatric Pulmonology
  • Pediatric Endocrinology

Background:

  • Inhaled corticosteroids (ICS) are a cornerstone therapy for pediatric asthma.
  • Systemic side effects, including adrenal suppression, can occur with moderate to high ICS doses.

Observation:

  • A 3-year-old boy with difficult-to-control asthma presented with hypoglycemia and unresponsiveness.
  • He had been treated with high-dose fluticasone propionate (750-1000 µg/day) and other asthma medications.
  • Cortisol axis suppression was noted, likely due to high-dose ICS.

Findings:

  • Severe acute adrenal crisis with hypoglycemia occurred in a child on high-dose ICS.
  • The patient did not exhibit typical Cushingoid features or growth impairment.
  • Partial cortisol axis suppression was attributed to fluticasone propionate therapy.

Implications:

  • Emphasizes the importance of using the lowest effective ICS dose in children with asthma.
  • Highlights the need for vigilant monitoring of systemic side effects in children on high-dose ICS.
  • Recommends liberal use of systemic steroids in emergency situations for these patients.

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