Males with Adrenal crisis induced by steroids

[Guest shortkids_1999]

Ho we are seeing the dangers of steroids

Michael

 

Warning on asthma medication

 

02mar03

 

PARENTS of children taking inhaled steroids to treat asthma have been warned to monitor them carefully after three children suffered severe side-effects.

 

The children required intensive hospital treatment after experiencing adrenal crises following long-term, high doses of the corticosteroid fluticasone.

Adrenal crisis is a potentially deadly condition if not treated, resulting from an extreme lack of adrenocortical hormones.

 

Symptoms are characterised by seizures, vomiting, lethargy and hypoglycaemia, or low levels of glucose in the blood.

 

Patients can appear to be in shock or coma.

 

 

 

 

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The cases, documented in the Medical Journal of Australia tomorrow, are the country's first recorded cases of adrenal crises related to inhaled steroids.

 

They follow widespread concern and reports of adverse reactions, including deaths, overseas.

 

The patients included a seven-year-old boy, a four-year-old boy and a 10-year-old boy who suffered a seizure after 24-hours of vomiting.

 

All three developed problems after they became sick with another infection.

 

"Our case series further highlights the potential for the systemic activity of ICS (inhaled corticosteroids) to manifest as an acute adrenal crisis," the report concludes.

 

Fluticasone, one of the newer ICS medicines, was most likely to cause adrenal problems because of its high potency, said the authors, from Sydney's Westmead Hospital.

 

However, all inhaled corticosteroids had been shown to produce adrenal suppression in children.

 

The report said screening for adrenal problems in children receiving high doses of corticosteroids was difficult, and the best approach was to alert parents to warning signs.

 

These included lethargy, vomiting, stomach pains or seizures.

 

"Parents of children taking high doses of inhaled corticosteroids should be alerted to the clinical features of adrenal insufficiency," the authors warned.

 

"If suspected, prompt medical assessment should be arranged.

 

"Prompt recognition and treatment ... may be lifesaving."

 

There was a suggestion the children had been over-treated, although some children may be more susceptible to suffering an adverse reaction than others, the authors noted.

 

They also said a UK survey found around 20 per cent of patients who suffered adrenal crises where later shown not to have had asthma.

 

The medication was also inappropriate for recurrent coughs and viral wheezing.

 

Endocrinologist Dr Kim Donaghue, of Westmead Hospital, said parents shouldn't panic and take their children off the medication, which was proven effective in treating asthma.

 

"You've got the two spectrums in asthma - you've got the children who aren't on sufficient medication and then there's a group who are probably on too much," she said.

 

"If parents are not sure they should have it assessed."

 

In a joint letter to the MJA, a group of seven Victorian asthma specialists said doctors could be over-prescribing corticosteroids because of a discrepancy between product information and national asthma guidelines.

 

They said current product information recommended a maximum daily dose of 1,000 mcg of fluticasone while the National Asthma Council set 500 mcg as the upper daily limit.

 

The letter said a recent study of 62 emergency patients showed almost a third of those using fluticasone were taking 1,000 mcg daily.

 

Nineteen per cent were taking more than 1,500 mcg.

 

"Our findings show that in some patients the risks associated with the use of ICS are likely to be compounded by using them at higher doses than recommended," they wrote.

 

 

 

[Guest Rose Marie]

Thanks ShortKids for the article. We have discussed inhaled steriods as being a cause for steriod-induced Cushings. Recently Simone was diagnosed with steriod-induced Cushings because of her inhaler. Hopefully this article and more like them will grace the desks of many physicians.

 

Thanks so much for sharing!

 

rm