Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids

Stephanie Hsu, Colleen Wood, Zhaoxing Pan, Haseeb Rahat, Philip Zeitler, David Fleischer, Calies Menard-Katcher, Glenn T. Furuta, Dan Atkins

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)135-140
Number of pages6
JournalPediatric, Allergy, Immunology, and Pulmonology
Volume30
Issue number3
DOIs
StatePublished - Sep 2017
Externally publishedYes

Fingerprint

Eosinophilic Esophagitis
Adrenal Insufficiency
Steroids
Pediatrics
Hydrocortisone
Endocrinology
Quality Improvement
Adrenocorticotropic Hormone
Multicenter Studies
Fasting
Emergencies
Referral and Consultation
Asthma
Pharmacology

Keywords

  • Asthma
  • cortisol
  • eosinophilic esophagitis
  • esophagitis
  • safety

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids. / Hsu, Stephanie; Wood, Colleen; Pan, Zhaoxing; Rahat, Haseeb; Zeitler, Philip; Fleischer, David; Menard-Katcher, Calies; Furuta, Glenn T.; Atkins, Dan.

In: Pediatric, Allergy, Immunology, and Pulmonology, Vol. 30, No. 3, 09.2017, p. 135-140.

Research output: Contribution to journalArticle

Hsu, S, Wood, C, Pan, Z, Rahat, H, Zeitler, P, Fleischer, D, Menard-Katcher, C, Furuta, GT & Atkins, D 2017, 'Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids', Pediatric, Allergy, Immunology, and Pulmonology, vol. 30, no. 3, pp. 135-140. https://doi.org/10.1089/ped.2017.0779
Hsu, Stephanie ; Wood, Colleen ; Pan, Zhaoxing ; Rahat, Haseeb ; Zeitler, Philip ; Fleischer, David ; Menard-Katcher, Calies ; Furuta, Glenn T. ; Atkins, Dan. / Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis Patients Treated with Swallowed Topical Steroids. In: Pediatric, Allergy, Immunology, and Pulmonology. 2017 ; Vol. 30, No. 3. pp. 135-140.
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