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- Title
Adrenal responses to a low-dose short synacthen test in children with asthma.
- 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.
- Abstract
Objectives 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. Design Patients were recruited from secondary care paediatric asthma populations within the UK. Patients Asthmatic children (5-18 years), receiving corticosteroids, underwent a LDSST ( n = 525). Measurements Demographics and corticosteroid doses were tested for association with baseline and peak (stimulated) cortisol concentrations. Results Baseline cortisol was significantly associated with age (log baseline increased 0·04 n m per year of age, P < 0·0001), but not with gender or corticosteroid dose. Peak cortisol was significantly associated with total corticosteroid cumulative dose (decreased 0·73 n m per 200 mcg/day, P < 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 m) occurred in 37·0% (161/435) overall, including children using GINA low (200-500 mcg/day beclomethasone-CFC equivalent 32%, n = 60), medium (501-1000 mcg/day (33%, n = 57) and high (>1000 mcg/day 40%, n = 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%, n = 27, P < 0·001). Conclusion 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.
- Subjects
ADRENOCORTICAL hormones; PEDIATRICS; SECONDARY care (Medicine); INTRANASAL medication; BECLOMETHASONE dipropionate
- Publication
Clinical Endocrinology, 2015, Vol 82, Issue 5, p648
- ISSN
0300-0664
- Publication type
Article
- DOI
10.1111/cen.12655