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Endocrine Effects of Inhaled Corticosteroids in Children

Chirag R. Kapadia, MD1; Todd D. Nebesio, MD2; Susan E. Myers, MD3; Steven Willi, MD4; Bradley S. Miller, MD, PhD5; David B. Allen, MD6; Elka Jacobson-Dickman, MD7 ; for the Drugs and Therapeutics Committee of the Pediatric Endocrine Society
[+] Author Affiliations
1Phoenix Children's Hospital, Phoenix, Arizona
2Riley Hospital for Children, Indiana University School of Medicine, Indianapolis
3Department of Pediatrics, St Louis University, Cardinal Glennon Children's Hospital, St Louis, Missouri
4Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
5University of Minnesota Masonic Children's Hospital, Minneapolis
6Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
7Division of Pediatric Endocrinology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
JAMA Pediatr. 2016;170(2):163-170. doi:10.1001/jamapediatrics.2015.3526.
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Inhaled corticosteroids (ICSs) are widely used as first-line treatment for various chronic respiratory illnesses. Advances in devices and formulations have reduced their local adverse effects. However, as delivery of ICSs to the lungs improves, the systemic absorption increases, and an adverse effect profile similar to, although milder than, oral corticosteroids has emerged. The most serious potential adverse effect is adrenal insufficiency, which can be life threatening. Adrenal insufficiency occurs most in patients taking the highest doses of ICSs but is reported with moderate or even low doses as well. Our recommendations include greater vigilance in testing adrenal function than current standard practice. In patients with diabetes mellitus (types 1 and 2), an increase in glucose levels is likely, and diabetes medication adjustment may be needed when initiating or increasing ICSs. The risk of linear growth attenuation and adverse effects on bone mineral density is generally low but should be considered in the face of additional risk factors. On behalf of the Pediatric Endocrine Society Drugs and Therapeutics Committee, we present a review of the endocrine adverse effects of ICSs in children and offer recommendations relating to testing and referral. Limited data in particular realms diminish the strength of certain recommendations, and clinical judgment continues to be paramount.

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