Salivary cortisol to assess the hypothalamic-pituitary-adrenal axis in healthy children under 3 years old

Silva, Margarete L.; Mallozi, Márcia C.; Ferrari, Giesela Fleischer

doi:10.2223/jped.1598

Cited by 21 publications

(28 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Inadequate sleep is more common among children living with parents who argue frequently [2] and family conflict has been reported to precede elevated cortisol levels in children [53]. Sleep deprivation in infants is associated with higher cortisol levels the next morning [10]. Caregiver stress in early life has been associated with increased levels of TNF-a in infants [51]; this proinflammatory cytokine is responsible for sleep control [30].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

Kozyrskyj¹,

Kendall²,

Zubrick³

et al. 2009

European Respiratory Journal

View full text Add to dashboard Cite

Sleep deprivation has become a common phenomenon of the Western world and is associated with a variety of medical problems in children. This retrospective longitudinal analysis of a community-based birth cohort was undertaken to determine whether frequent nocturnal awakening during early life was associated with the development of childhood asthma.2,398 children born to mothers recruited from the antenatal clinics of a single hospital in Perth, Australia during 1989-1991 were followed up at years 1, 2, 3, 6, 8, 10 and 14. Parent-completed questionnaires were analysed. The odds ratio for asthma at age 6 and 14 yrs in children with frequent nocturnal awakening during the first 3 yrs after birth was determined from multiple logistic regression.Following adjustment for asthma risk factors, co-sleeping and family stress, persistent nocturnal awakening was associated with nonatopic asthma at age 6 and 14 yrs (at age 14 yrs: OR 2.18, 95% CI 1.15-4.13) but not with atopic asthma.We found an increased risk of nonatopic asthma in children following frequent nocturnal awakening during the first 3 yrs of life. These hypothesis-generating data suggest the need for further systematic study of the effects of disordered sleep in early life on the development of asthma.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Higher morning cortisol and lower growth hormone levels have been observed in sleep-deprived infants and children [10][11][12]. Shorter stature is more common in children with asthma [13].…”

mentioning

confidence: 99%

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

Kozyrskyj¹,

Kendall²,

Zubrick³

et al. 2009

European Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…31 As preterm infants do not exhibit diurnal rhythm, sampling can occur anytime. 24,33 Thus, based on previous studies, we decided to use 1.0 mcg kg À1 cosyntropin with cortisol levels before and 40 min after cosyntropin administration. In order to take into account the wide variability of cortisol levels with and without a stimulation test in healthy and sick neonates, we used the percentage change in cortisol levels from baseline as the result of the study for the ROC curve analysis.…”

Section: à2mentioning

confidence: 99%

The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants

2012

View full text Add to dashboard Cite

Objective: To investigate if in preterm newborns, an early adrenocorticotropin hormone (ACTH) test can identify possible transient adrenal insufficiency (TAI), using significant hypotension as a clinical marker.Study Design: We studied 40 premature newborns born 24 to 29 weeks gestational age (GA) before 8 h of life. Serum cortisol levels were obtained before and 40 min after administration of 1.0 mcg kg À1 cosyntropin.Inotropes were used to treat hypotension based on clinical assessment following no response to fluid boluses. Functional echocardiogram was used to support the clinical diagnosis of hypotension. The accuracy of the ACTH test was evaluated using receiver operating characteristic (ROC) curve.Result: Study patients had mean GA of 26.6 weeks and birth weight of 876 g. In all, 30% required inotropes. The area under the ROC curve for the ACTH test was 87%. Using a cutoff of an increase in cortisol below 12% from baseline had 75% sensitivity and 93% specificity for detecting hypotension. This cutoff was associated with bronchopulmonary dysplasia (8/12 vs 7/28, 95% CI: 0.1 to 0.72), but not with other morbidities or death.Conclusion: An early ACTH test using the above cutoff has high specificity for detecting hypotension, and thus, can serve as a marker for potential TAI in preterm newborns. Future studies should focus on identifying those newborns for which steroid supplementation would be most beneficial.

show abstract

“…40,41 Recently, Silva et al used this method to assess the HPA axis in Brazilian children aged 45 days to 36 months, establishing reference values that will be useful to studies that investigate adrenal insufficiency in the future. 42 Determination of free cortisol in 24-hour urine is not indicated for assessing lack of HPA axis function since less than 1% of free cortisol is excreted in urine. 28 Therefore, this test is more used to assess hypercortisolism, which is a situation in which transcortin saturation occurs, thereby making increased excretion of free cortisol in urine possible.…”

Section: Relapse Of the Underlying Diseasementioning

confidence: 99%

Retirada da corticoterapia: recomendações para a prática clínica

Alves¹,

Robazzi²,

Mendonça³

2008

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

Objective: To present an up-to-date and practical review of how to safely withdraw glucocorticosteroid therapy.Sources: A review of the published literature identified by searching the MEDLINE and LILACS databases (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), selecting the most representative articles on the subject. Summary of the findings:Three clinical situations may occur during glucocorticoid withdrawal: adrenal insufficiency secondary to negative feedback on the hypothalamic-pituitary adrenal (HPA) axis, steroid withdrawal syndrome and relapse of the disease for which the glucocorticoids were prescribed. Although there is no consensus on how to best discontinue prolonged glucocorticosteroid therapy, there is agreement that this withdrawal should be gradual.This article updates pediatricians on how to recognize these problems and provides recommendations on how to safely suspend glucocorticosteroid therapy. A brief review of the pharmacology of glucocorticoids is also presented. Conclusion:There is no good predictive test for predicting the risk of adrenal insufficiency in patients who have been on corticosteroid therapy chronically. There is a need for prospective studies to assess the true incidence of this problem and to propose rational strategies for preventing it. The current recommendation is that patients who have been on chronic and/or high dose glucocorticoids should be administered glucocorticoids during stress situations unless the integrity of the HPA axis has been established by dynamic tests. (Rio J). 2008;84(3):192-202: Adrenal insufficiency, Cushing's syndrome, steroid withdrawal therapy, corticosteroid. J Pediatr

show abstract

Salivary cortisol to assess the hypothalamic-pituitary-adrenal axis in healthy children under 3 years old

Cited by 21 publications

References 24 publications

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

The use of an early ACTH test to identify hypoadrenalism-related hypotension in low birth weight infants

Retirada da corticoterapia: recomendações para a prática clínica

Contact Info

Product

Resources

About