Hypothalamic-pituitary-adrenal function in children with asthma and rhinitis treated with topical glucocorticosteroids.
BACKGROUND
The risk of suppression of hypothalamic-pituitary-adrenal (HPA) function in children on topical glucocorticosteroids is currently much debated.


OBJECTIVE
To review data on HPA function in children with asthma and rhinitis on topical glucocorticosteroids, and to discuss the value of HPA function measures in clinical practice and research.


METHODS
A review of peer refereed data.


CONCLUSIONS
There is no evidence that insufflated or inhaled glucocorticosteroids in recommended doses have ever caused clinically significant HPA insufficiency in any child. Using sensitive measures of basal adrenal activity, however, several studies have found suppressive effects with specific drugs, high doses and application systems. These observations may represent homeostatic diminution in endogenous cortisol. Such measures have no place in the management of children on topical glucocorticosteroids, but may be useful in clinical trials assessing systemic activity of administration regimens and application devices. In children growth suppression seems to the most important adverse effect of topical glucocorticosteroids.
Wolthers
O D
OD
Department of Paediatrics, Randers Hospital, Denmark.
Honour
J W
JW
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D005938:Glucocorticoids; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000503:physiopathology; D012220:Rhinitis / Q000188:drug therapy* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids