Assessment of adrenal suppression in children with asthma treated with inhaled corticosteroids: use of dehydroepiandrosterone sulfate as a screening test.
BACKGROUND
Inhaled corticosteroids (ICs) are considered first-line therapy for persistent asthma. At medium to high doses, ICs can suppress the hypothalamic-pituitary-adrenal (HPA) axis. Various provocative stimuli have been used to evaluate HPA axis function, but they are labor intensive and time-consuming. Dehydroepiandrosterone sulfate (DHEA-S) is a corticotropin-dependent adrenal androgen precursor that is suppressible in patients treated with ICs.


OBJECTIVE
To evaluate DHEA-S as a possible marker for HPA axis dysfunction in children treated with ICs.


METHODS
Children with moderate-to-severe persistent asthma and a history of medium- to high-dose IC exposure for at least 6 months were evaluated using low-dose and standard high-dose cosyntropin stimulation testing to assess adrenal function, and DHEA-S levels were compared with the results.


RESULTS
Thirteen (59%) of 22 patients exhibited an abnormal cortisol response to cosyntropin. Age- and sex-specific mean DHEA-S z scores were significantly lower in cosyntropin abnormal responders (-1.2822) compared with normal responders (0.2964) (P = .008). The receiver operating characteristic curve for DHEA-S z scores had an area of 0.786 (95% confidence interval, 0.584-0.989), reaching 100% sensitivity with a DHEA-S z score of -1.5966 or less and 100% specificity with a DHEA-S z score greater than 0.0225.


CONCLUSIONS
Most children develop biochemical evidence of adrenal suppression after treatment with medium to high doses of ICs. The presence of low DHEA-S levels can be used as a screening test to identify the child who needs more formal testing of the HPA axis.
Dorsey
Morna J
MJ
Division of Immunology, Children's Hospital Boston, Harvard Medical School, Massachusetts, USA. mdorsey@hsc.usf.edu
Cohen
Laurie E
LE
Phipatanakul
Wanda
W
Denufrio
Danielle
D
Schneider
Lynda C
LC
D000280:Administration, Inhalation; D000304:Adrenal Cortex Function Tests / Q000379:methods*; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000175:diagnosis*; D001249:Asthma / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002648:Child; D003366:Cosyntropin; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D008297:Male; D008403:Mass Screening; D010913:Pituitary-Adrenal System / Q000187:drug effects; D012372:ROC Curve
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D003366:Cosyntropin; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone