Casebook of
Pediatrics
in morning and 5 mg in evening. With steroid replacement therapy, his pigmentation lessened and he had no further recurrence of asthmatic attacks. He is doing well on follow up.
Discussion Addison’s disease with initial presentation as bronchial asthma had rarely been reported in children.1 Green et al and Harris et al reported that there was a possible relationship between Addison’s disease and asthma.2,3 In most of the cases, both these symptoms appeared together but in a few cases, clinical features of Addison’s disease were absent.4 In a retrospective survey of 481 patients with Addison’s disease, 27 were described as having allergic disease.5 In our case, the parents noticed that the child’s wheezing attacks and skin pigmentation developed simultaneously but yet it was not taken as significant and evaluated in the previous admissions. Glucocorticoids are involved in modulation of β-adrenoreceptor density and responsiveness.6 In the steroid-deficient state, β-adrenergic receptors of bronchi decrease in number or lose responsiveness to catecholamines presenting clinically with wheeze. A favorable response in asthma to steroid therapy will also support this fact. Asthma may be an uncommon presenting sign of Addison’s disease because a child developing
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adrenal failure needs to be just on the threshold of bronchoconstriction for the latter to occur before other features of Addison’s disease. We report this case to alert physicians caring for children with asthma that in the presence of hyperpigmentation in a child with wheezing, Addison’s disease should be entertained as a possible association.
References 1.
Saraclar Y, Turktas I, Adalioglu G, Tuncer A. Bronchial asthma with Addison’s disease. Respiration 1993;60:241-2.
2.
Green M, Lim KH. Bronchial asthma with Addison’s disease. Lancet 1971;1:1159-62.
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Harris PW, Collins JV. Bronchial asthma with Addison’s disease. Lancet 1971;1:1349-50.
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Sanerkin NG, El-Shaboury AH. Chronic adrenalitis with bronchial asthma. Lancet 1965;7:468-70.
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Carryer HM, Sherrick DW, Gastineau CF. Occurrence of allergic disease inpatients with adrenal cortical hypofunction. J Am Med Assoc 1960;172:1356-60.
6.
Reinhardt D. Adrenoreceptors and the lung: their role in health and disease. Eur J Pediatr 1989;148:286-93.