Iatrogenic Adrenal Cortex Failure in Patients with Steroid Dependent Asthma in Relation to Different Methods of Glucocorticoid Treatment.
OBJECTIVE: To evaluate and compare the degree of adrenal cortex suppression in patients receiving long term treatment with different formulas and doses of glucocorticoids (GC) which is of considerable diagnostic and therapeutic importance. METHODS: A total of 97 subjects (51 women and 46 men) with bronchial asthma was divided into the groups subjected to different GC treatment (e.g. inhalation, oral and intramuscular GC). In all patients total blood serum and free salivary cortisol was estimated under basal conditions and after Synacthen stimulation as well as free cortisol and its metabolites in 24 hour urine. RESULTS: Reduced adrenal reserve was found in 58.33 % of patients chronically treated with systemic GC, in 21.05 % of patients periodically treated with systemic GC and in 9.09 % of patients treated with inhaled GC. CONCLUSIONS: Inhaled GC caused a small degree of adrenal cortex suppression and thus should be preferred in the treatment of bronchial asthma. In addition, free salivary and urinary cortisol levels are a useful non-invasive method of evaluating adrenal cortex function in patients with bronchial asthma.