Recovery of hypothalamo–pituitary–adrenal axis suppression during treatment with inhaled corticosteroids for childhood asthma

Abstract

ObjectiveTo describe recovery of adrenal insufficiency in asthmatic children treated with inhaled corticosteroids (ICS) and cortisol replacement therapy.DesignRetrospective, observational study.PatientsA total of 113 patients, 74 male; age 10.4 (3.3–16.5) years; beclomethasone-equivalent ICS dose, 800 μg, (100–1,000), tested by low dose short Synacthen (tetracosactide) test (LDSST), were studied. Test results were classified by basal and peak cortisol concentration: “normal” (basal >100 nmol/L, peak >500 nmol/L), “suboptimal” (basal >100 nmol/L, peak 350–499 nmol/L), “abnormal” (basal <100 nmol/L and/or peak <350 nmol/L). Patients with suboptimal results received hydrocortisone during periods of stress only, and those with abnormal responses received daily hydrocortisone, increased during periods of stress. A total of 73 patients (68%) had ≥2 LDSSTs over 2.2 years (0.2–7.7).MeasurementsChange in cortisol response to repeat LDSST (movement between diagnostic groups, difference in basal and peak cortisol >15% [2× the inter-assay coefficient of variation]), change in BMI and height standard deviation score (SDS).ResultsBaseline test results were abnormal in 17 patients (15%) and all of them had repeat tests. In 13 patients (76%), test results improved (normal in six, suboptimal in seven) and four (24%) remained abnormal. Baseline tests results were suboptimal in 54 patients (48%), of whom 50 (93%) were retested. Repeat tests were normal in 36 patients (72%), remained suboptimal in 11 (22%), and were abnormal in three (6%). Baseline tests results were normal in 42 patients, of whom six patients (14%) were retested. Results remained normal in three (50%), were suboptimal in two (33%), and abnormal in one (17%). Basal and peak cortisol levels increased by >15% in 33/73 (45%) and 42/73 (57%) patients, respectively, and decreased by >15% in 14/73 (19%) and 7/73 (10%), respectively. There was no significant change in height or BMI SDS.ConclusionRecovery of adrenal function is common and occurs during continued ICS and cortisol replacement therapy.

Immunocytochemical assessment of FKBP51 and Glucocorticoid receptor localization in asthmatic patients

“…Oral or high doses of inhaled corticosteroids block the release of CRH and ACTH and then lower cortisol level. This Insufficiency continued even after treatment cessation for more than one year, with no significant difference between non steroid treated patients and the control subjects, while the results were within the reference range [32].…”

Research on the establishment of chronic stress‐induced premature ovarian failure the rat model and effects of Chinese medicine Muniziqi treatment

“…The pituitary–ovarian axis (HPO axis) interacts at multiple points. In recent years, with the deepening of research, the mechanism of the influence of stress on ovarian function in the hypothalamus, pituitary, and especially ovarian levels has been further revealed (Gangadharan et al, ; Gupta & Morley, ).…”

“…Clinical studies have shown that women with excessively high sensory pressure have decreased levels of LH, elevated levels of FSH, decreased serum E2, and progesterone levels and increased ovulation cycle (Kudielka, Hellhammer & Wüst, 2009) interacts at multiple points. In recent years, with the deepening of research, the mechanism of the influence of stress on ovarian function in the hypothalamus, pituitary, and especially ovarian levels has been further revealed (Gangadharan et al, 2017;Gupta & Morley, 2014).…”

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression

“…[26] Even when ICS doses are not reduced, HPAS seems to resolve in some patients. [27] This may be due to poor adherence to therapy or an increase in airway diameter with age, resulting in better control with reduced ICS doses.…”