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Inhaled corticosteroid systemic absorption — MRCPCH TAS MCQ

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HardPharmacologyInhaled corticosteroid systemic absorptionMRCPCH TAS

A 9-year-old with severe asthma uses high-dose inhaled corticosteroid and frequent oral steroid bursts. Growth velocity has fallen and morning cortisol is low. What is the most likely explanation?

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Correct answer: D — Systemic glucocorticoid exposure suppressing adrenal function

High-dose inhaled corticosteroids can have systemic effects, especially with repeated oral steroid exposure, leading to adrenal suppression and impaired growth velocity. Beta-2 receptor downregulation may reduce bronchodilator response but does not explain low cortisol. The pearl is to use the lowest effective steroid dose and monitor growth in children.

Reference: BNFc; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi