Fatal and near-fatal encephalopathy with hyponatraemia in two siblings with fluticasone-induced adrenal suppression

Aim: To document previously unreported acute effects of adrenal insufficiency. Methods: We describe two siblings who presented acutely with hyponatraemia and cerebral oedema following prolonged treatment with high dose inhaled fluticasone. Results: A girl aged 5.5 years presented with vomiting, head...

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Bibliographic Details
Published in:Acta Paediatrica 2007-05, Vol.96 (5), p.769-772
Main Authors: Donaldson, MDC, Morrison, C, Lees, C, McNeill, E, Howatson, AG, Paton, JY, McWilliam, R
Format: Article
Language:English
Subjects:
Administration, Inhalation
Adrenal Glands - drug effects
Adrenal Insufficiency - chemically induced
Adrenal Insufficiency - complications
Androstadienes - administration & dosage
Androstadienes - adverse effects
Anti-Asthmatic Agents - administration & dosage
Anti-Asthmatic Agents - adverse effects
Biological and medical sciences
Brain Edema - etiology
Cerebral oedema
Child
Encephalopathy
Fatal
Fatal Outcome
Female
Fluticasone
General aspects
Glucocorticoids - administration & dosage
Glucocorticoids - adverse effects
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
High dose Fluticasone
Humans
Hyponatraemia
Hyponatremia - etiology
Male
Medical sciences
Near fatal
Nervous system (semeiology, syndromes)
Neurology
Siblings
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Summary:Aim: To document previously unreported acute effects of adrenal insufficiency. Methods: We describe two siblings who presented acutely with hyponatraemia and cerebral oedema following prolonged treatment with high dose inhaled fluticasone. Results: A girl aged 5.5 years presented with vomiting, headache, visual impairment and seizures. She was hyponatraemic but not hypoglycaemic. Her conscious level continued to deteriorate and she died, post mortem examination showing small adrenal glands and cerebral oedema. Four weeks later her 7‐year‐old brother presented with similar symptoms. Assessment showed hyponatraemia with cerebral oedema. His illness responded to intensive care. A diagnosis of adrenal insufficiency was made retrospectively in both cases. The siblings had been receiving Fluticasone propionate (FP) in doses of up to 2000 μg/day for several years. Conclusion: We believe that the hyponatraemia and cerebral oedema was related to cortisol deficiency, leading to impaired excretion of water. We emphasize the need for careful cerebral monitoring in acute adrenal insufficiency presenting with impaired consciousness.
ISSN:0803-5253
1651-2227
DOI:10.1111/j.1651-2227.2007.00251.x