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01.12.2014 | Case report | Ausgabe 1/2014 Open Access

Italian Journal of Pediatrics 1/2014

Hydrocortisone malabsorption due to polyethylene glycols (Macrogol 3350) in a girl with congenital adrenal insufficiency

Zeitschrift:
Italian Journal of Pediatrics > Ausgabe 1/2014
Autoren:
Stefano Stagi, Paolo Del Greco, Franco Ricci, Chiara Iurato, Giovanni Poggi, Salvatore Seminara, Maurizio de Martino
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13052-014-0078-2) contains supplementary material, which is available to authorized users.

Competing interest

The authors declare that there are no conflicts of interest that could be perceived as prejudicing the impartiality of the research reported.

Authors' contributions

SStagi: conception and design, endocrinological evaluation, manuscript writing and final approval of the manuscript. FR: data collection and analysis, manuscript writing and final approval of the manuscript. PDG: data collection and analysis, manuscript writing and final approval of the manuscript. CI: endocrinological evaluation, data collection and analysis, manuscript writing and final approval of the manuscript. GP: data collection and analysis, critical revision and final approval of the manuscript. SSeminara: endocrinological evaluation, critical revision and final approval of the manuscript. MdM: critical revision and final approval of the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Primary adrenal insufficiency is relatively rare in children and, if unrecognized, may present with cardiovascular collapse, making it a potentially life-threatening entity.

Case presentation

The proposita, 11 months old of age, was admitted for lethargy and severe dehydration. Blood pressure was 62/38 mm Hg, and biochemical measurements showed hyponatraemia, hypochloraemia, hyperkalaemia, and metabolic acidaemia. Renin activity was 1484 μU/mL; cortisol, 1.03 μg/dL (normal, 5-25 μg/dL); and corticotropin (ACTH), 4832 ng/L (normal, 9-52 ng/L). Adrenal deficiency was diagnosed, and replacement therapy with glucocorticoids and mineralocorticoids was initiated. After 40 days, ACTH was 797 ng/L.
During follow-up, the patient started taking macrogol twice daily for constipation and experienced a significant increase in ACTH (3262 ng/L), which dropped to 648 ng/L when macrogol was stopped. After arbitrary reintroduction of macrogol, the child presented with hypoglycaemia, lethargy, weakness, and hypotonia; ACTH was 3145 ng/L. After again stopping macrogol, her ACTH was near normalized (323 ng/L).

Conclusion

Hydrocortisone malabsorption may be caused by macrogol use. Because chronic constipation is frequently reported in children, the possibility that macrogol contributes to adrenal crisis should be taken in account.
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