Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children.
Pediatrics
; 130(6): e1512-9, 2012 Dec.
Article
en En
| MEDLINE
| ID: mdl-23147980
ABSTRACT
BACKGROUND AND OBJECTIVE:
Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS.METHODS:
Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of âpostmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed.RESULTS:
Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity <80% was associated with HPAS (odds ratio = 4.1 [95% confidence interval 1.0-14.8]). Daily ICS + NS/m(2) dose was correlated with the postmetyrapone ACTH (r = -0.29, P < .001). BMI (P = .048) and percent adherence to ICS (P < .001) and NS (P = .002) were predictive of âpostmetyrapone ACTH (R(2) = .176).CONCLUSIONS:
Two-thirds of children on corticosteroids may have hypothalamic-pituitary-adrenal axis dysfunction. In one-third, central function had recovered but adrenal suppression persisted. Predictive factors for HPAS are NS use, BMI, and adherence to ICS and NS.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Sistema Hipófiso-Suprarrenal
/
Asma
/
Hidrocortisona
/
Corticoesteroides
/
Insuficiencia Suprarrenal
/
Antiasmáticos
/
Hipopituitarismo
/
Enfermedades Hipotalámicas
/
Sistema Hipotálamo-Hipofisario
/
Antiinflamatorios
Tipo de estudio:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Pediatrics
Año:
2012
Tipo del documento:
Article
País de afiliación:
Sudáfrica