Clinical features of adrenal insufficiency in eight patients identified to have hypothalamic–pituitary–adrenal suppression during inhaled corticosteroid treatment
| Case, sex | Clinical features at presentation (age) | Age in y | Height in cm (SDS) | Weight in kg (SDS) | HPA function at presentation (plasma cortisol in nmol/l) | Inhaled corticosteroid, daily dose (dose/m2/day) device; duration |
| 1, M | Acute: unconscious, plasma glucose 0.9 mmol/l (4.5 y) | 4.5 | 98.2 (−2.0) | 14.1 (−2.1) | Plasma cortisol 100 at 08001-150, SDST peak 200 | Fluticasone 500 μg/day (780 μg/m2/day) volumatic; 6 mth |
| 6.3 | 108.5 (−1.8) | 18.6 (−1.1) | ||||
| 2, F | Acute: drowsy, disoriented and headache for 24 h, plasma glucose 0.7 mmol/l. Also had poor growth in height and weight for 12 mth (5.8 y) | 4.8 | 104.0 (−0.7) | 17.0 (−0.3) | Plasma cortisol 30 at 09001-150, SDST peak 30 | Budesonide 400 μg/day (570 μg/m2/day) nebuhaler; 15 mth, followed by fluticasone 500 μg/day (705 μg/m2/day) volumatic; 4 mth |
| 5.8 | 106.0 (−1.7) | 17.0 (−1.2) | ||||
| 7.0 | 119.7 (−0.3) | 24.4 (0.4) | ||||
| 3, M | Insidious: weight loss and listlessness for 3 mth (4.5 y) | 4.2 | 97.8 (−1.5) | 15.1 (−1.0) | Plasma cortisol 100 at 08301-150, SDST peak 20 | Fluticasone 500 μg/day (770 μg/m2/day) volumatic; 6 mth |
| 4.7 | 101.1 (−1.5) | 14.9 (−1.7) | ||||
| 7.0 | 118.5 (−0.6) | 22.5 (−0.1) | ||||
| 4, M | Insidious: poor growth in height and weight for 2 y (8.0 y) | 5.8 | 109.0 (−1.1) | 18.5 (−0.7) | Plasma cortisol <20 at 09001-150, SDST peak <20 | Fluticasone 500 μg/day (610 μg/m2/day) volumatic; 4.5 y |
| 8.0 | 114.6 (−2.4) | 21.2 (−1.4) | ||||
| 9.7 | 126.7 (−1.6) | 30.9 (0.1) | ||||
| 5, M | Insidious: poor growth in height and weight for 12 mth (10.0 y) | 9.0 | 121.9 (−2.0) | 22.1 (−1.9) | Plasma cortisol 90 at 09001-150, SDST peak 300 | Beclomethasone dipropionate 600 μg/day (690 μg/m2/day) dischaler; 3 y |
| 10.0 | 125.0 (−2.2) | 23.3 (−2.2) | ||||
| 11.2 | 130.6 (−2.0) | 26.9 (−1.8) | ||||
| 6, F | Insidious: poor growth in height and weight for 2 y (9.8 y) | 6.1 | 110.7 (−1.0) | 17.1 (−1.4) | Plasma cortisol 162 at 09001-150; 24 h urine cortisol metabolites low1-151 (THC 380 μg, THE 70 μg) | Budesonide 400 μg/day (505 μg/m2/day) nebuhaler; 5 y |
| 9.3 | 120.0 (−2.4) | 18.8 (−3.2) | ||||
| 11.3 | 137.0 (−1.2) | 27.6 (−1.7) | ||||
| 7, M | Insidious: poor growth in height and hirsutism for 6 mth (5.6 y) | 4.8 | 99.6 (−1.9) | 16.0 (−1.1) | Plasma cortisol <20 and 30 at 09001-150; 24 h urine cortisol metabolites undetectable1-151 | Budesonide 400 μg/day (595 μg/m2/day) nebuhaler; 12 mth |
| 5.6 | 101.5 (−2.5) | 17.1 (−1.2) | ||||
| 6.7 | 111.5 (−1.6) | 19.6 (−1.0) | ||||
| 8, F | Insidious: poor growth in height and headaches for 12 mth (8.4 y) | 7.2 | 116.0 (−1.2) | 21.0 (−0.7) | Plasma cortisol 33 at 09001-150, SDST peak 325 | Fluticasone 1000 μg/day (1136 μg/m2/day) volumatic; 18 mth |
| 8.5 | 119.5 (−1.9) | 23.5 (−0.8) | ||||
| 10.1 | 128.0 (−1.6) | 33.9 (0.2) |
Rows in bold represent measurements after the diagnosis of adrenal insufficiency.
↵1-150 0700–0900 plasma cortisol (normal range 250–700 nmol/l).
↵1-151 24 h urine cortisol metabolites: THC, tetrahydrocortisol (normal range 500–1300 μg); THE, tetrahydrocortisone (normal range 200–550 μg).
SDST, standard dose Synacthen (ACTH) test (criterion for normal response is peak plasma cortisol >500 nmol/l).