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

Authors Gangadharan A, McCoy P, Phyo A, McGuigan MP, Dharmaraj P, Ramakrishnan R, McNamara PS, Blair J

Published 15 December 2017 Journal of Asthma and Allergy Volume 2017:10 Pages 317—326

DOI https://doi.org/10.2147/JAA.S142874

Objective: To describe recovery of adrenal insufficiency in asthmatic children treated with inhaled corticosteroids (ICS) and cortisol replacement therapy.

Design: Retrospective, observational study.
Patients: A 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 2.2="" 73="" a="" abnormal="" and="" daily="" during="" had="" hydrocortisone="" increased="" ldssts="" nbsp="" nmol="" of="" only="" or="" over="" patients="" peak="" periods="" received="" responses="" results="" span="" stress.="" stress="" suboptimal="" those="" total="" with="" years="">
Measurements: Change 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).
Results: Baseline 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.
Conclusion: Recovery of adrenal function is common and occurs during continued ICS and cortisol replacement therapy.

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