SHORT-TERM, HIGH-DOSE, SYSTEMIC STEROIDS IN CHILDREN WITH ASTHMA - THE EFFECT ON THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS

[摘要] Children with chronic asthma frequently receive bursts (less than 7 days) of short-term, high-dose prenisone (1 to 2 mg/kg/day) for acute exacerbations of their disease. Certain of these patients may also require inhaled corticosteroids (IC) for control. The effect of these bursts on the hypothalamic-pituitary-adrenal axis (HPAA) is unclear. To test the integrity of the HPAA in such patients, we measured plasma cortisol (F) in response to serial administration of insulin-induced hypoglycemia (nadir = 34 .+-. 1.2 mg/dl; .hivin.x .+-. SE), followed by 250 .mu.g/1.73 m2 of synthetic ACTH in the following children with asthma: group I, seven patients who received no more than one burst per year (0.71 .+-. 0.2); group II, six individuals who received more than one burst per year (3.6 .+-. 0.2) and no IC; and group III, 10 subjects who received more than one burst per year (4.7 .+-. 0.3) plus IC. All patients received daily theophylline and .beta.-agonists: seven patients were taken sodium cromolyn. No patients received troleandomycin. Compared to group I (control subjects), 16% of group II had a subnormal response of F to hypoglycemia. In addition, a subnormal response of F to hypoglycemia or ACTH was documented in 20% and 10% of group III, respectively. All individuals with a subnormal response of F to either hypoglycemia or ACTH received four or more bursts per year. We conclude that as a group, children affected by asthma treated with bursts alone or bursts plus Ic appear to have a normal HPAA. However, among those subjects receiving either four or more bursts per year or IC plus four or more bursts, some have a subnormal response to hypoglycemia stress and ACTH, suggesting they may be at risk for adrenal insufficiency.

[发布日期] 1987-07-01