Evaluation of adrenocortical function in 3-7 aged asthmatic children treated with moderate doses of fluticasone propionate: reliability of dehydroepiandrosterone sulphate (dhea-s) as a screening test.
BACKGROUND
Inhaled corticosteroids (ICS) are the first-line therapy in the treatment of persistent asthma. At medium to high doses and prolonged usage, ICS can supresss the hypothalamic-pituitary-adrenal axis. Dehydroepiandrosterone sulphate (DHEA-S) is a corticotropin-dependent adrenal androgen precursor that is supressible in patients treated with ICS.


OBJECTIVE
To evaluate the adrenal axis in asthmatic children treated with moderate doses of fluticasone propionate and to evaluate the DHEA-S as a possible marker for adrenal axis ın preadrenarchal children.


METHODS
Twenty-eight children with persistent asthma with a mean age of 4.4 years (median 4.2; range 2.5-7.1) on long term treatment (mean 6.16; median 6; range 4.5-9 months) with moderate doses (mean 250; median 253; range 158-347 (g/m(2)/day) of inhaled fluticasone propionate were evaluated with low-dose ACTH stimulation test to assess adrenal function, and DHEA-S levels were compared with the results.


RESULTS
One out of 28 patients (3.57%) demonstrated an abnormal cortisol response to low-dose ACTH test. There was no correlation between DHEA-S and peak cortisol, morning cortisol and fasting blood glucose levels. However, mean inhaled corticosteroid dosages were inversely correlated with the DHEA-S.


CONCLUSIONS
In most of the children with persistent asthma, mild to moderate fluticazone propionate doses supress the hypothalamic-pituitary-adrenal axis rarely. Chronic moderate doses of ICS may suppress adrenal androgen levels without supression of cortisol production. DHEA-S levels may be used as a practical method to follow adrenal functions and may be an earlier indicator of adrenal dysfunction in children.
Department of Pediatric Allergy, Dr Sami Ulus Children's Hospital, 06080 Ankara, Turkey. umsahner@yahoo.com
U M
UM
Sahiner
S
S
Cetinkaya
S
S
Ozmen
Z
Z
Arslan
D000730:Androstadienes / Q000009:adverse effects*; D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D001993:Bronchodilator Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007118:Immunoassay; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects*
D000730:Androstadienes; D015415:Biomarkers; D001993:Bronchodilator Agents; D019314:Dehydroepiandrosterone Sulfate; D000068298:Fluticasone