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Fatal and near-fatal encephalopathy with hyponatraemia in two siblings with fluticasone-induced adrenal suppression

M D C Donaldson1, C Morrison, C Lees

  • 1Division of Developmental Medicine, University of Glasgow, UK. mdcd1t@clinmed.gla.ac.uk

Acta Paediatrica (Oslo, Norway : 1992)
|March 23, 2007
PubMed

Insights

High-dose inhaled fluticasone propionate (FP) can cause acute adrenal insufficiency, leading to hyponatremia and cerebral edema. This rare but serious side effect requires careful monitoring in children.

Area of Science:

  • Pediatric Endocrinology
  • Pharmacology
  • Neurology

Background:

  • Inhaled corticosteroids are widely used for pediatric respiratory conditions.
  • Prolonged high-dose use of inhaled fluticasone propionate (FP) may lead to systemic absorption and adverse effects.
  • Acute adrenal insufficiency is a rare but potentially life-threatening condition.

Observation:

  • Two siblings presented with acute symptoms including vomiting, headache, visual impairment, seizures, and hyponatremia.
  • One sibling died, with post-mortem findings of adrenal hypoplasia and cerebral edema.
  • The surviving sibling also showed hyponatremia and cerebral edema, responding to intensive care.

Findings:

  • Retrospective diagnosis of adrenal insufficiency in both siblings.
  • Causal link between prolonged high-dose inhaled FP (up to 2000 mcg/day) and acute adrenal insufficiency.
  • Hyponatremia and cerebral edema attributed to cortisol deficiency and impaired water excretion.

Implications:

  • Highlights previously unreported acute effects of high-dose inhaled FP.
  • Emphasizes the need for vigilance and careful cerebral monitoring in pediatric patients with acute adrenal insufficiency.
  • Underscores the importance of considering endocrine side effects with long-term high-dose inhaled corticosteroid therapy.
Abstract

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