Early morning salivary cortisol and cortisone, and adrenal responses to a simplified low‐dose short <scp>S</scp>ynacthen test in children with asthma

Blair, Joanne; Lancaster, Gillian; Titman, Andrew; Peak, Matthew; Newlands, Paul; Collingwood, Catherine; Chesters, Christine; Moorcroft, T; Wallin, Naomi; Hawcutt, Daniel B; Gardner, C.; Didi, Mohammed; Lacy, David; Couriel, Jon

doi:10.1111/cen.12302

Cited by 39 publications

(41 citation statements)

References 27 publications

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“…Cortisol concentrations in the early morning correlate strongly with peak cortisol concentrations in dynamic tests of adrenal function5 9 10 and have been reported to be helpful screening tests in children and young people. The sensitivity and specificity of a cortisol concentration <108 nmol/L at 9:00 for the diagnosis of adrenal insufficiency are reported to be 83% and 99%, respectively, while adrenal insufficiency is unlikely when 9:00 cortisol is >381 nmol/L 11…”

Section: Diagnostic Tests Of Adrenal Functionmentioning

confidence: 99%

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The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

2016

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The diagnosis and treatment of adrenal insufficiency in childhood and adolescence poses a number of challenges. Clinical features of chronic adrenal insufficiency are vague and non-specific, and mimic many other causes of chronic ill health. A range of diagnostic tests are available for the assessment of adrenal function, all of which have advantages and disadvantages. Cortisol responses to these tests may vary with age and between genders. Knowledge of normal cortisol levels during health and ill health in childhood is also limited, and the cortisol replacement therapies available in clinical practice enable only crude mimicry of physiological patterns of cortisol secretion. An awareness of the limitations of diagnostic tests and treatments is important, and critical clinical assessment, integrating clinical and biochemical data, is essential for the diagnosis and treatment of children with suspected adrenal insufficiency. The aim of this review is to draw on data from clinical studies to inform a pragmatic approach to the child presenting with symptoms of chronic adrenal insufficiency. Clinical features of primary and secondary adrenal insufficiency, and syndromes associated with these diagnoses are described. Factors to consider when selecting a diagnostic test of adrenal function and interpretation of test results are considered. Finally, the limitations of cortisol replacement therapy are also discussed.

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Section: Diagnostic Tests Of Adrenal Functionmentioning

confidence: 99%

“…The LDSST can be technically challenging; sampling at 5 min intervals is recommended for identification of cortisol peaks,25 although sampling at 10 min intervals may also be acceptable 5. The only available concentration of Synacthen is 250 µg/mL.…”

Section: Diagnostic Tests Of Adrenal Functionmentioning

confidence: 99%

The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

2016

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“…Measurement of salivary cortisol is becoming routine in some clinics for the assessment of adrenal function. Late‐night salivary cortisol testing is now recommended as a first‐line diagnostic test in Cushing's syndrome, and there are reports of its use in the diagnosis of adrenal insufficiency . Advocates of salivary measurements favour its convenience and potential cost savings over serum sampling.…”

Section: Introductionmentioning

confidence: 99%

Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Elder

Harrison

Cross

et al. 2017

Clinical Endocrinology

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“…However, with increasing case reports of adrenal insufficiency with the use of ICS, the importance of understanding the risk factors associated with HPA suppression have become more obvious. In fact, some studies have shown that as many as 20-50% of children treated with ICS had biomedical abnormalities of the HPA axis (8). Fluticasone propionate is much more likely to cause clinically symptomatic adrenal suppression compared to other ICS like beclomethasone, triamcinolone and budesonide.…”

Section: Glucocorticoid and Childhood Asthmamentioning

confidence: 99%

Recovery of steroid induced adrenal insufficiency

Younes

2017

Transl. Pediatr

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Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6-12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

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Early morning salivary cortisol and cortisone, and adrenal responses to a simplified low‐dose short Synacthen test in children with asthma

Abstract: Our data illustrate that basal measures of cortisol are likely to be of value in screening populations for patients at greatest risk of adrenal crisis. EMSCn shows promise as a screening tool for the identification of patients with severe adrenal insufficiency.

Cited by 39 publications

References 27 publications

The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

The diagnosis and treatment of adrenal insufficiency during childhood and adolescence

Use of salivary cortisol and cortisone in the high‐ and low‐dose synacthen test

Recovery of steroid induced adrenal insufficiency

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