Use of a radioreceptor assay in the assessment of cushingoid features in patients with juvenile rheumatic diseases.
A marked variation has been observed in severity of cushingoid appearance in patients with rheumatic diseases (RD) following steroid administration. We studied ten children with RD to determine if a relationship exists between cushingoid features and an individual's steroid activity as measured by prednisolone equivalents using a radioreceptor assay. Cushingoid features were clinically assessed by a "cushing score" according to the method of Bergrem. Patients were assigned to either the cushingoid (C) or noncushingoid (NC) group at study entry according to their cushing score. Blood was drawn prior to prednisone ingestion and then at 30, 60, 90, 120, 240, and 360 minutes and each sample was assessed for prednisolone equivalents and also for free and total cortisol. Group comparisons of dose-adjusted area under curve (AUC) and peak response are reported. Cushingoid patients had higher plasma prednisolone equivalents (PE) than noncushingoid patients as measured by peak PE and AUC. The PE.6 h/L average AUC for C patients was 248 micrograms PE.6 h/L versus 134 micrograms PE.6 h/L for NC patients. This nearly twofold difference was also noted between mean peak values (C 82 micrograms/L vs. NC 44 micrograms/L). Spearman correlations of Cushing scores with these two parameters indicated significant (p less than 0.05) relationships. A patient's Cushing score correlated best with peak response (rs = 0.78) and also with AUC (rs = 0.72). Measurement of plasma peak PE or AUC could be valuable for individualizing steroid dosing in children with RD.
Lipnick
R N
RN
Department of Rheumatology, Children's National Medical Center, Washington, DC 20010.
Morales
A
A
Getson
P R
PR
White
P H
PH
Soldin
S J
SJ
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000097:blood*; D001171:Arthritis, Juvenile / Q000097:blood / Q000150:complications*; D002648:Child; D003480:Cushing Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003882:Dermatomyositis / Q000097:blood / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis; D008297:Male; D011239:Prednisolone / Q000097:blood / Q000493:pharmacokinetics; D011869:Radioligand Assay / Q000379:methods*
D000305:Adrenal Cortex Hormones; D011239:Prednisolone