Adrenal responses to a low-dose short synacthen test in children with asthma

作者：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

来源：Clinical Endocrinology, 2015, 82(5): 648-656.

DOI：10.1111/cen.12655

ObjectivesCorticosteroids 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.
DesignPatients were recruited from secondary care paediatric asthma populations within the UK.
PatientsAsthmatic children (5-18years), receiving corticosteroids, underwent a LDSST (n=525).
MeasurementsDemographics and corticosteroid doses were tested for association with baseline and peak (stimulated) cortisol concentrations.
ResultsBaseline cortisol was significantly associated with age (log baseline increased 004nm per year of age, P<00001), but not with gender or corticosteroid dose. Peak cortisol was significantly associated with total corticosteroid cumulative dose (decreased 073nm per 200mcg/day, P<0001) but not with age, gender inhaled/intranasal corticosteroid cumulative dose or number of courses of rescue corticosteroids. Biochemically impaired response (peak cortisol 500nm) occurred in 370% (161/435) overall, including children using GINA low (200-500mcg/day beclomethasone-CFC equivalent 32%, n=60), medium (501-1000mcg/day (33%, n=57) and high (>1000mcg/day 40%, n=13) doses of inhaled corticosteroid (ICS) similarly, and 366% of those using fluticasone ICS 500mcg/day (71/194). Impaired response was more frequent in patients on regular oral corticosteroids (66%, n=27, P<0001).
ConclusionChildren 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.

• 出版日期2015-5