CUSHINGS-SYNDROME FROM AN INHALED GLUCOCORTICOID

Objective: To report a case of significant systemic side effects from an inhaled glucocorticoid at a reported dose in the upper recommended therapeutic range. Clinical features: A 25-year-old white man with ast hma treated with inhaled glucocorticoid (beclomethasone 1500 mu g dail y), and primary testicular failure with inadequate androgen replacemen t, was referred with back pain. He was found to have osteoporosis, cli nical features of Cushing's syndrome and complete suppression of endog enous adrenocorticotrophic hormone adrenal function. Intervention and outcome: He was recommended to receive adequate androgen replacement a nd to use a spacer device with the inhaled beclomethasone, or to chang e to budesonide via a Turbuhaler (AB Astra, Sweden). Conclusions: Inha led glucocorticoids should not be regarded as entirely safe, as seriou s systemic side effects may occur at doses at the upper level of the r ecommended therapeutic range.