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Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Overt glucocorticoid excess due to inhaled corticosteroid therapy
1Department of Pediatrics, University of Wisconsin, School of Medicine, Madison.
Inhaled corticosteroids for childhood asthma are generally safe. However, one case showed that inhaled triamcinolone acetonide can cause excess glucocorticoid effects, requiring careful monitoring.
Area of Science:
- Pediatric Pulmonology
- Endocrinology
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are a cornerstone in managing pediatric asthma.
- Current pediatric ICS like beclomethasone dipropionate and triamcinolone acetonide are not typically associated with significant hypothalamic-pituitary-adrenal (HPA) axis suppression or Cushingoid side effects.
Observation:
- A case study involving an 8-year-old girl with asthma treated solely with inhaled triamcinolone acetonide is presented.
- The patient developed obesity, hirsutism, and growth retardation during therapy.
Findings:
- Laboratory results indicated suppression of endogenous cortisol production without complete HPA axis suppression.
- Discontinuation of inhaled triamcinolone acetonide led to the resolution of clinical signs (obesity, hirsutism), normalization of growth, and restoration of normal cortisol levels and urinary steroid excretion.
Implications:
- This case highlights the potential for systemic absorption and adverse glucocorticoid effects from inhaled triamcinolone acetonide in children.
- Routine monitoring of growth velocity and, when clinically warranted, morning serum cortisol levels is crucial for early detection of excess glucocorticoid effects in pediatric asthma patients using ICS.
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