Adrenal suppression in an asthmatic presenting after change from high dose inhaled fluticasone propionate to inhaled budesonide

Case description A ten-year-old boy with asthma, peanut allergy, and allergic rhinitis had been maintained on a regimen of FP/salmeterol 500 mcg per day and mometasone furoate nasal spray 50 mcg per day. During exacerbations FP 500 mcg per day was added. He had no oral steroid usage. After a stable period with only FP/salmeterol, his regimen was changed to BUD/formoterol 800 mcg per day. Shortly after this change in regimen, he began to experience spells of dizziness, fatigue, nausea and diaphoresis with exercise. A random glucose was low at 3.4 mol/L and an AM cortisol was low at 67 nmol/L. With endocrinologist recommendation adrenal suppression was diagnosed, hydrocortisone therapy at 18 mg/m and ciclesonide were initiated. He is currently stable, tapering hydrocortisone therapy, with plans for ACTH stimulation test when hydrocortisone is discontinued.