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Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids.
Pediatric Allergy, Immunology, and Pulmonology ( IF 0.9 ) Pub Date : 2017-10-25 , DOI: 10.1089/ped.2017.0779
Stephanie Hsu 1 , Colleen Wood 1 , Zhaoxing Pan 2, 3 , Haseeb Rahat 1 , Philip Zeitler 1 , David Fleischer 3, 4 , Calies Menard-Katcher 3, 5 , Glenn T Furuta 3, 5 , Dan Atkins 3, 4
Affiliation  

Swallowed topical steroids (STS) are the only effective pharmacological therapy for eosinophilic esophagitis (EoE). Thus far, studies of small populations of EoE patients have reported conflicting results in relation to adrenal insufficiency (AI). We sought to measure AI in a clinical setting in children taking STS for EoE. We performed a quality improvement study of pediatric EoE patients seen in a multidisciplinary clinic, who were treated with STS for at least 3 months. Two hundred twenty-five patients completed questionnaires to assess for signs of AI. All patients were requested to have fasting morning cortisol levels completed and if abnormal (<5 μg/dL or 139 nmol/L) twice, endocrinology consultation, and low-dose adrenocorticotropic hormone stimulation test were performed. A peak stimulated cortisol level of <18 μg/dL or 500 nmol/L was diagnostic of AI. Five of 106 STS-treated EoE patients who had morning cortisol levels drawn had AI. All 5 of these patients had asthma and were on additional topical steroid treatments. The number of steroid modalities and dose of steroid were not significant risk factors. Despite this low percentage, the life-threatening potential of AI warrants patient screening, as patients with iatrogenic AI are typically asymptomatic until an emergency triggers adrenal crisis. Further multicenter studies are needed to better define the risk attributable to STS alone, particularly in patients receiving combined steroid modalities.

中文翻译:

吞咽局部类固醇治疗的小儿嗜酸性食管炎患者的肾上腺功能不全。

吞咽局部类固醇(STS)是嗜酸性粒细胞性食管炎(EoE)的唯一有效药理疗法。迄今为止,对少量EoE患者的研究报告了与肾上腺功能不全(AI)有关的矛盾结果。我们试图在临床环境中对接受STS进行EoE的儿童进行AI测量。我们对在多学科门诊接受STS治疗至少3个月的儿科EoE患者进行了质量改善研究。225名患者完成了问卷以评估AI征象。要求所有患者完成早晨的空腹皮质醇水平,如果两次异常(<5μg/ dL或139 nmol / L),则进行内分泌学咨询和小剂量促肾上腺皮质激素刺激试验。刺激皮质醇的峰值水平< 18μg/ dL或500 nmol / L可诊断为AI。在106名接受STS治疗的EoE患者中,有5名早晨服用了皮质醇,他们中有5名患有AI。这些患者中的所有5例均患有哮喘,并接受其他局部类固醇治疗。类固醇模式的数量和类固醇剂量不是重要的危险因素。尽管百分比很低,但AI威胁生命的潜力值得筛查,因为在紧急情况引发肾上腺危机之前,医源性AI患者通常无症状。需要进一步的多中心研究以更好地确定仅由STS引起的风险,特别是在接受联合类固醇治疗的患者中。类固醇模式的数量和类固醇剂量不是重要的危险因素。尽管百分比很低,但AI威胁生命的潜力值得筛查,因为在紧急情况引发肾上腺危机之前,医源性AI患者通常无症状。需要进一步的多中心研究以更好地确定仅由STS引起的风险,特别是在接受联合类固醇治疗的患者中。类固醇模式的数量和类固醇剂量不是重要的危险因素。尽管百分比很低,但AI威胁生命的潜力值得筛查,因为在紧急情况引发肾上腺危机之前,医源性AI患者通常无症状。需要进一步的多中心研究以更好地确定仅由STS引起的风险,特别是在接受联合类固醇治疗的患者中。
更新日期:2019-11-01
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