Adrenal crisis caused by inhaled fluticasone in an adolescent with cystic fibrosis and advanced hepatopathy: a case report

Abstract

Inhaled corticosteroids are widely accepted in the treatment of cystic fibrosis. Long-term use may cause systemic complications, especially high-dose fluticasone. We report about a young man who presented with encephalopathy after excessive physical activity caused by secondary adrenal insufficiency. He recovered quickly after systemic corticosteroid replacement therapy. This problem is considered to be underdiagnosed in clinical practice.

Figure 1

Forced vital capacities and forced expiratory volumes in percent of predicted values (FVCp, FEV1p) from August 1999 until the adrenal crisis in October 2008 show only a slight lung affection of the CF patient. Fluticasone has been prescribed since 1999 in a current dose of 500 μg per day. All visits on which the patient had body plethysmography are listed (month/year). The data after 2008 show the CF disease inherent worsening of lung function.