{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:21Z","timestamp":1784557041049,"version":"3.55.0"},"reference-count":20,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"Summary<\/jats:title>\n A 55-year-old woman with asthma presented with adrenal insufficiency of unknown origin. She was referred to our Division of Reproductive Endocrinology to further evaluate an undetectable morning cortisol level discovered during the evaluation of a low serum DHEA-S level. She was asymptomatic other than having mild fatigue and weight gain. Her medication list included 220\u200a\u03bcg of inhaled fluticasone propionate twice daily for asthma, which she was taking as prescribed. On presentation, the undetectable morning cortisol level was confirmed. A urinary measurement of fluticasone propionate 17\u03b2-carboxylic acid was markedly elevated. Fluticasone therapy was discontinued and salmeterol therapy initiated with supplemental hydrocortisone. Hydrocortisone therapy was discontinued after 2 months. A repeat urinary fluticasone measurement 4 months after the discontinuation of fluticasone therapy was undetectably low and morning cortisol level was normal at 18.0\u200a\u03bcg\/dl. Inhaled fluticasone is generally considered to be minimally systemically absorbed. This patient's only clinical evidence suggesting adrenal insufficiency was fatigue accompanying a low serum DHEA-S level. This case demonstrates that adrenal insufficiency can be caused by a routine dose of inhaled fluticasone. Missing this diagnosis could potentially result in adrenal crisis upon discontinuation of fluticasone therapy.<\/jats:p>\n \n Learning points<\/jats:title>\n \n \n \n Standard-dose inhaled fluticasone can cause adrenal insufficiency.<\/jats:p>\n <\/jats:list-item>\n \n Adrenal insufficiency should be considered in patients taking, or who have recently discontinued, inhaled fluticasone therapy and present with new onset of nonspecific symptoms such as fatigue, weakness, depression, myalgia, arthralgia, unexplained weight loss, and nausea that are suggestive of adrenal insufficiency.<\/jats:p>\n <\/jats:list-item>\n \n Adrenal insufficiency should be considered in postoperative patients who exhibit signs of hypoadrenalism after fluticasone therapy has been withheld in the perioperative setting.<\/jats:p>\n <\/jats:list-item>\n \n Routine screening for hypoadrenalism in patients without clinical signs or symptoms of adrenal insufficiency after the discontinuation of inhaled fluticasone therapy is not indicated due to the apparently low incidence of adrenal insufficiency caused by fluticasone.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1530\/edm-13-0080","type":"journal-article","created":{"date-parts":[[2014,1,23]],"date-time":"2014-01-23T04:21:42Z","timestamp":1390450902000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":3,"title":["Adrenal insufficiency in a woman secondary to standard-dose inhaled fluticasone propionate therapy"],"prefix":"10.1530","volume":"2014","author":[{"given":"Casey M","family":"Hay","sequence":"first","affiliation":[{"name":"1Department of Obstetrics and Gynecology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel I","family":"Spratt","sequence":"additional","affiliation":[{"name":"2Division of Reproductive Endocrinology and Infertility, Maine Medical Center, 22 Bramhall Street, Portland, Maine 04102, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref31","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1183\/09031936.95.08040579","article-title":"High dose fluticasone propionate, 1\u200amg daily, versus fluticasone propionate, 2\u200amg daily, or budesonide, 1.6\u200amg daily, in patients with chronic severe asthma. International Study Group","volume":"8","year":"1995","journal-title":"European Respiratory Journal"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/0954-6111(95)90259-7","article-title":"Fluticasone propionate \u2013 an update on preclinical and clinical experience","volume":"89","year":"1995","journal-title":"Respiratory Medicine"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0091-6749(98)70292-1","article-title":"Hypothalamic\u2013pituitary\u2013adrenal axis suppression associated with the use of inhaled fluticasone propionate","volume":"102","year":"1998","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1136\/adc.87.6.457","article-title":"Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom","volume":"87","year":"2002","journal-title":"Archives of Disease in Childhood"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/S0091-6749(98)70292-1","article-title":"Hypothalamic\u2013pituitary\u2013adrenal axis suppression associated with the use of inhaled fluticasone propionate","volume":"102","year":"1998","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1468-1293.2008.00579.x","article-title":"Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature","volume":"9","year":"2008","journal-title":"HIV Medicine"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/adc.88.6.554","article-title":"Adrenal crisis due to inhaled steroids is underestimated","volume":"88","year":"2003","journal-title":"Archives of Disease in Childhood"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1136\/bmj.304.6839.1415-a","article-title":"Acute adrenal insufficiency associated with high dose inhaled steroids","volume":"304","year":"1992","journal-title":"BMJ"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"769","DOI":"10.2165\/00002018-200831090-00005","article-title":"Inhaled corticosteroids and adrenal insufficiency: prevalence and clinical presentation","volume":"31","year":"2008","journal-title":"Drug Safety"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1183\/09031936.95.08040579","article-title":"High dose fluticasone propionate, 1\u200amg daily, versus fluticasone propionate, 2\u200amg daily, or budesonide, 1.6\u200amg daily, in patients with chronic severe asthma. International Study Group","volume":"8","year":"1995","journal-title":"European Respiratory Journal"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1001\/archinte.159.9.941","article-title":"Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis","volume":"159","year":"1999","journal-title":"Archives of Internal Medicine"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"769","DOI":"10.2165\/00002018-200831090-00005","article-title":"Inhaled corticosteroids and adrenal insufficiency: prevalence and clinical presentation","volume":"31","year":"2008","journal-title":"Drug Safety"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1136\/bmj.304.6839.1415-a","article-title":"Acute adrenal insufficiency associated with high dose inhaled steroids","volume":"304","year":"1992","journal-title":"BMJ"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1136\/adc.87.6.457","article-title":"Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom","volume":"87","year":"2002","journal-title":"Archives of Disease in Childhood"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1001\/archinte.159.9.941","article-title":"Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis","volume":"159","year":"1999","journal-title":"Archives of Internal Medicine"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1177\/0009922812462235","article-title":"Moderate dose inhaled corticosteroid-induced symptomatic adrenal suppression: case report and review of the literature","volume":"51","year":"2012","journal-title":"Clinical Pediatrics"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/j.1468-1293.2008.00579.x","article-title":"Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone: a review of the literature","volume":"9","year":"2008","journal-title":"HIV Medicine"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/0954-6111(95)90259-7","article-title":"Fluticasone propionate \u2013 an update on preclinical and clinical experience","volume":"89","year":"1995","journal-title":"Respiratory Medicine"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1177\/0009922812462235","article-title":"Moderate dose inhaled corticosteroid-induced symptomatic adrenal suppression: case report and review of the literature","volume":"51","year":"2012","journal-title":"Clinical Pediatrics"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1136\/adc.88.6.554","article-title":"Adrenal crisis due to inhaled steroids is underestimated","volume":"88","year":"2003","journal-title":"Archives of Disease in Childhood"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2014\/1\/EDM13-0080.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2014\/1\/EDM13-0080.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:45:53Z","timestamp":1784555153000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,1]]},"references-count":20,"URL":"https:\/\/doi.org\/10.1530\/edm-13-0080","relation":{},"ISSN":["2052-0573","2052-0573"],"issn-type":[{"value":"2052-0573","type":"print"},{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,1]]}}}