Asthma and Cushing's syndrome

A female patient was treated with high-dose inhaled fluticasone propionate for her asthma, Over 2 years, she developed features of Gushing's syndrome with proximal myopathy, osteopenia, hypertension, depressive psychosis, and cushingoid appearance. She had biochemical evidence of marked adrenal supp ression with a 9:00 AM serum cortisol of 20 nmol/L that returned to normal (315 mol/L) after her therapy was changed to budenoside, 0.8 mg/d, Her appe arance, mental state, and myopathy also improved with no loss of asthma con trol. This case illustrates the potential for developing clinically relevan t adverse effects of inhaled corticosteroids when given at licensed doses.