title: A search for variables predicting cortisol response to low-dose corticotropin stimulation following supraphysiological doses of glucocorticoids.
abstract: OBJECTIVE
  To determine which biological or clinical variables may predict cortisol response to low-dose adrenocorticotropic hormone (ACTH) stimulation following supraphysiological doses of glucocorticoids in children.
  
  
  METHODS
  This retrospective study included all patients who underwent ACTH testing (1 μg) between October 2008 and June 2010 at the Sainte-Justine University Hospital Center, Montreal, after supraphysiological doses of glucocorticoids.
  
  
  RESULTS
  Data from 103 patients (median age, 8.0 years; range, 0.6-18.5 years; 57 girls) were analyzed, revealing growth deceleration in 37% and excessive weight gain in 33%. Reasons for glucocorticoid treatment included asthma (n = 30) and hematologic (n = 22), dermatologic (n = 19), rheumatologic (n = 16), and miscellaneous (n = 16) disorders. The following information was recorded: duration of glucocorticoid treatment (median, 374 days; range, 5-4226 days); duration of physiological hydrocortisone replacement (median, 118 days; range, 0-1089 days); maximum daily (median, 200 mg/m(2)/day; range, 12-3750 mg/m(2)/day) and cumulative (median, 16 728 mg/m(2); range, 82-178 209 mg/m(2)) doses, in hydrocortisone equivalents; and interval since the last dose (median, 43 days; range, 1-1584 days). Sixty-two patients (58%) exhibited a normal response (ie, peak cortisol >500 nmol/L) to ACTH stimulation. Peak cortisol level was not related to sex, prior morning cortisol level, duration of treatment, or cumulative glucocorticoid dose; 28% of the patients with normal baseline cortisol levels nevertheless demonstrated a subnormal response to ACTH.
  
  
  CONCLUSIONS
  Given the absence of clinical or biological predictors of the cortisol response to ACTH after suppressive doses of glucocorticoids, physicians have only 2 options: (1) empirically advocate glucocorticoid stress coverage during 18 months after cessation of high-dose glucocorticoid treatment; or (2) perform serial ACTH testing in all such patients until a normal peak cortisol level is attained.
authors: Endocrinology Service and Research Center, Sainte-Justine University Hospital Center and Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
authors: Stefanie
authors: S
authors: Wildi-Runge
authors: Johnny
authors: J
authors: Deladoëy
authors: Carole
authors: C
authors: Bélanger
authors: Cheri L
authors: CL
authors: Deal
authors: Guy
authors: G
authors: Van Vliet
authors: Nathalie
authors: N
authors: Alos
authors: Céline
authors: C
authors: Huot
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000097:blood*; D007223:Infant; D008297:Male; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D011241:Prednisone; D006854:Hydrocortisone
keywords: ACTH; Adrenocorticotropic hormone; HPA; Hypothalamic-pituitary-adrenal; ITT; Insulin tolerance test