BTNL2 gene variant and sarcoidosis.

is a safe test when performed in experienced centres. Indeed, a review of .6500 ITTs reported that only seven patients (0.1%) experienced an adverse event, all of which reversed following intravenous glucose. To our knowledge, only two studies have used the ITT to investigate the HPA axis in asthmatic children treated with inhaled fluticasone. The first reported an inadequate response to insulin-induced hypoglycaemia in three children taking 1000–2250 mg/day. In the second study, nine of 18 subjects treated with 250– 750 mg/day for up to 16 weeks exhibited evidence of adrenal suppression which recovered following cessation of treatment. Finally, as hypopituitarism of probable autoimmune aetiology has been reported in patients with celiac disease, the possibility that autoimmune hypophysitis contributed to the patients’ symptoms and pituitary deficiency cannot be definitively excluded. In summary, this report suggests that inhaled (together with intranasal) fluticasone may suppress the HPA axis in adults and that symptomatic adrenal insufficiency may develop, particularly if dosing is variable and intermittent. These cases illustrate that clinical symptoms may alert the physician to the possibility of adrenal suppression which can then be confirmed using basal and/or stimulated tests of HPA function in selected patients. Further investigation to determine the prevalence of these effects in adult patients is warranted.