Adrenal responses to a low‐dose short synacthen test in children with asthma. (22nd December 2014)

• Record Type: Journal Article
• Authors: Hawcutt, Daniel B.; Jorgensen, Andrea L.; Wallin, Naomi; Thompson, Ben; Peak, Matthew; Lacy, David; Newland, Paul; Didi, Mo; Couriel, Jon; Blair, Jo; Pirmohamed, Munir; Smyth, Rosalind L.
• Is Part Of: Clinical endocrinology. Volume 82:Number 5(2015:May)
• Page Start: 648
• Page End: 656
• Publication Date: 2014-12-22
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12655
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12655-abs-0001"> <title>Summary</title> <sec id="cen12655-sec-0001" sec-type="section"> <title>Objectives</title> <p>Corticosteroids are known to cause adrenal suppression. The aim of this study was to assess clinical factors affecting responses to a low dose short synacthen test (LDSST) in asthmatic children using corticosteroids.</p> </sec> <sec id="cen12655-sec-0002" sec-type="section"> <title>Design</title> <p>Patients were recruited from secondary care paediatric asthma populations within the UK.</p> </sec> <sec id="cen12655-sec-0003" sec-type="section"> <title>Patients</title> <p>Asthmatic children (5–18 years), receiving corticosteroids, underwent a LDSST (<italic>n</italic> = 525).</p> </sec> <sec id="cen12655-sec-0004" sec-type="section"> <title>Measurements</title> <p>Demographics and corticosteroid doses were tested for association with baseline and peak (stimulated) cortisol concentrations.</p> </sec> <sec id="cen12655-sec-0005" sec-type="section"> <title>Results</title> <p>Baseline cortisol was significantly associated with age (log baseline increased 0·04 n<sc>m</sc> per year of age, <italic>P</italic> < 0·0001), but not with gender or corticosteroid dose. Peak cortisol was significantly associated with total corticosteroid cumulative dose (decreased 0·73 n<sc>m</sc> per 200 mcg/day, <italic>P</italic> < 0·001) but not with age, gender inhaled/intranasal corticosteroid cumulative dose or number of courses of rescue corticosteroids. Biochemically impaired response (peak cortisol ≤500 n<sc>m</sc>) occurred in 37·0% (161/435) overall, including children using GINA low (200–500 mcg/day beclomethasone‐CFC equivalent 32%, <italic>n</italic> = 60), medium (501–1000 mcg/day (33%, <italic>n</italic> = 57) and high (>1000 mcg/day 40%, <italic>n</italic> = 13) doses of inhaled corticosteroid (ICS) similarly, and 36·6% of those using fluticasone ICS ≥500 mcg/day (71/194). Impaired response was more frequent in patients on regular oral corticosteroids (66%, <italic>n</italic> = 27, <italic>P</italic> < 0·001).</p> </sec> <sec id="cen12655-sec-0006" sec-type="section"> <title>Conclusion</title> <p>Children with asthma can develop biochemical adrenal suppression at similar frequencies for all ICS preparations and doses. The clinical consequence of biochemical suppression needs further study.</p> </sec> </abstract>