title: Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on inhaled and nasal corticosteroids--more common than expected?
abstract: BACKGROUND
  Hypothalamic pituitary adrenal axis suppression (HPAS) when treating asthmatic children with inhaled corticosteroids (ICS) is thought to be rare.
  
  
  OBJECTIVE
  To determine the prevalence of HPAS in asthmatic children treated with ICS and nasal steroids (NS).
  
  
  METHODS
  Twenty-six asthmatic children were recruited. Clinical features of HPAS, height, weight, height and weight velocity, steroid dose, adherence, symptom control and lung functions were documented. Metyrapone test was performed if the serum cortisol was > 83 nmol/L (> 3 microg/dL).
  
  
  RESULTS
  No child had a serum cortisol < 83 nmol/L (< 3 microg/dL). Prevalence of HPAS was 35 (CI = 17%-56%). Daily NS dose/ m2 and cumulative NS dose/m2 were significantly (p = 0.03) inversely correlated with the post-metyrapone ACTH (r = -0.42 for both). Current ICS dose was not associated with the post-metyrapone ACTH (r = 0). There was a weak correlation with the daily ICS dose/m2 (r = -0.12) and cumulative ICS dose/m2 (r = -0.26).
  
  
  CONCLUSIONS
  A third of asthmatic children on ICS and NS develop HPAS. Contributing factors are the use of NS, body size and cumulative dose of ICS.
authors.affiliation: Paediatric Endocrine Unit, Tygerberg Children's Hospital, University of Stellenbosch, Cape Town, South Africa. zollner@sun.ac.za
authors.forename: Ekkehard Werner
authors.initials: EW
authors.lastname: Zöllner
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Ushma
authors.initials: U
authors.lastname: Galal
authors.forename: Stephen
authors.initials: S
authors.lastname: Hough
authors.forename: Elvis
authors.initials: E
authors.lastname: Irusen
authors.forename: Eugene
authors.initials: E
authors.lastname: Weinberg
mesh_terms: D000280:Administration, Inhalation; D000281:Administration, Intranasal; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000453:epidemiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D008297:Male; D008797:Metyrapone; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D015995:Prevalence; D012307:Risk Factors; D013252:Steroid 11-beta-Hydroxylase / Q000037:antagonists & inhibitors; D014421:Turkey / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D004791:Enzyme Inhibitors; D019819:Budesonide; D000324:Adrenocorticotropic Hormone; D013252:Steroid 11-beta-Hydroxylase; D006854:Hydrocortisone; D008797:Metyrapone