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首页> 外文期刊>Archives of disease in childhood >Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom.
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Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom.

机译：英国吸入皮质类固醇相关的肾上腺危机调查。

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BACKGROUND: Until recently, only two cases of acute adrenal crisis associated with inhaled corticosteroids (ICS) had been reported worldwide. We identified four additional cases and sought to survey the frequency of this side effect in the United Kingdom. METHODS: Questionnaires were sent to all consultant paediatricians and adult endocrinologists registered in a UK medical directory, asking whether they had encountered asthmatic patients with acute adrenal crisis associated with ICS. Those responding positively completed a more detailed questionnaire. Diagnosis was confirmed by symptoms/signs and abnormal hypothalamic-pituitary-adrenal axis function test results. RESULTS: From an initial 2912 questionnaires, 33 patients met the diagnostic criteria (28 children, five adults). Twenty-three children had acute hypoglycaemia (13 with decreased levels of consciousness or coma; nine with coma and convulsions; one with coma, convulsions and death); five had insidious onset of symptoms. Four adults had insidious onset of symptoms; one had hypoglycaemia and convulsions. Of the 33 patients treated with 500-2000 micro g/day ICS, 30 (91%) had received fluticasone, one (3%) fluticasone and budesonide, and two (6%) beclomethasone. CONCLUSIONS: The frequency of acute adrenal crisis was greater than expected as the majority of these patients were treated with ICS doses supported by British Guidelines on Asthma Management. Despite being the least prescribed and most recently introduced ICS, fluticasone was associated with 94% of the cases. We therefore advise that the licensed dosage of fluticasone for children, 400 micro g/day, should not be exceeded unless the patient is being supervised by a physician with experience in problematic asthma. We would also emphasise that until adrenal function has been assessed patients receiving high dose ICS should not have this therapy abruptly terminated as this could precipitate adrenal crisis.
机译：背景：直到最近，全世界仅有2例与吸入皮质类固醇（ICS）相关的急性肾上腺危机病例。我们确定了另外四个案例，并试图调查在英国这种副作用的发生频率。方法：将问卷调查表发送给在英国医疗目录中注册的所有儿科医生顾问和成人内分泌学家，询问他们是否遇到了患有ICS并伴有急性肾上腺危机的哮喘患者。积极回答的人填写了更详细的调查表。症状/体征和下丘脑-垂体-肾上腺轴功能检查结果异常证实诊断。结果：从最初的2912份问卷中，有33例符合诊断标准（28名儿童，5名成人）。 23例儿童患有急性低血糖症（13例意识或昏迷水平降低; 9例出现昏迷和惊厥; 1例出现昏迷，惊厥和死亡）; 13例患有低血糖。五个有隐伏的症状发作。有四名成年人有隐伏的症状发作。一人患有低血糖和抽搐。在接受500-2000 micro g / day ICS治疗的33例患者中，有30例（91％）接受了氟替卡松，1例（3％）氟替卡松和布地奈德，2例（6％）倍氯米松。结论：急性肾上腺危机的发生率高于预期，因为这些患者中的大多数接受了英国《哮喘管理指南》支持的ICS剂量的治疗。尽管氟替卡松是处方药最少且最近才引入的ICS，但与94％的病例相关。因此，我们建议不要超过儿童氟替卡松的许可剂量400微克/天，除非患者在有问题哮喘经验的医师的监督下进行治疗。我们还将强调，在评估肾上腺功能之前，接受大剂量ICS的患者不应突然终止该治疗，因为这可能会引发肾上腺危机。

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