Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children
Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS. Clinical features of HPAS, doses, adherence, asthma score, and lung functions...
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| Veröffentlicht in: | Pediatrics (Evanston) 2012-12, Vol.130 (6), p.e1512-e1519 |
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| creator | Zöllner, Ekkehard Werner Lombard, Carl J Galal, Ushma Hough, F Stephen Irusen, Elvis M Weinberg, Eugene |
| description | Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS.
Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of √postmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed.
Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval: 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity |
| doi_str_mv | 10.1542/peds.2012-1147 |
| format | Article |
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Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of √postmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed.
Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval: 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity <80% was associated with HPAS (odds ratio = 4.1 [95% confidence interval: 1.0-14.8]). Daily ICS + NS/m(2) dose was correlated with the postmetyrapone ACTH (r = -0.29, P < .001). BMI (P = .048) and percent adherence to ICS (P < .001) and NS (P = .002) were predictive of √postmetyrapone ACTH (R(2) = .176).
Two-thirds of children on corticosteroids may have hypothalamic-pituitary-adrenal axis dysfunction. In one-third, central function had recovered but adrenal suppression persisted. Predictive factors for HPAS are NS use, BMI, and adherence to ICS and NS.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2012-1147</identifier><identifier>PMID: 23147980</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Administration, Inhalation ; Adolescent ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Adrenal insufficiency ; Adrenal Insufficiency - blood ; Adrenal Insufficiency - chemically induced ; Adrenocorticotropic Hormone - blood ; Anti-Asthmatic Agents - administration & dosage ; Anti-Asthmatic Agents - adverse effects ; Anti-Inflammatory Agents - administration & dosage ; Anti-Inflammatory Agents - adverse effects ; Asthma - drug therapy ; Asthma - physiopathology ; Asthma in children ; Child ; Child, Preschool ; Childhood asthma ; Children & youth ; Company distribution practices ; Correlation analysis ; Cortodoxone - blood ; Cross-Sectional Studies ; Demographic aspects ; Distribution ; Female ; Hormones ; Humans ; Hydrocortisone - blood ; Hypopituitarism - blood ; Hypopituitarism - chemically induced ; Hypopituitarism - epidemiology ; Hypothalamic Diseases - blood ; Hypothalamic Diseases - chemically induced ; Hypothalamic Diseases - epidemiology ; Hypothalamic-pituitary-adrenal axis ; Hypothalamo-Hypophyseal System - drug effects ; Hypothalamo-Hypophyseal System - physiopathology ; Linear Models ; Male ; Medical treatment ; Medication Adherence ; Metered Dose Inhalers ; Metyrapone ; Pediatrics ; Physiological aspects ; Pilot Projects ; Pituitary gland ; Pituitary-Adrenal System - drug effects ; Pituitary-Adrenal System - physiopathology ; Predictive Value of Tests</subject><ispartof>Pediatrics (Evanston), 2012-12, Vol.130 (6), p.e1512-e1519</ispartof><rights>Copyright American Academy of Pediatrics Dec 1, 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-cadd3d16dc3e24766110a74a14c61218a839018a56228559bf1321105cc6508b3</citedby><cites>FETCH-LOGICAL-c361t-cadd3d16dc3e24766110a74a14c61218a839018a56228559bf1321105cc6508b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23147980$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zöllner, Ekkehard Werner</creatorcontrib><creatorcontrib>Lombard, Carl J</creatorcontrib><creatorcontrib>Galal, Ushma</creatorcontrib><creatorcontrib>Hough, F Stephen</creatorcontrib><creatorcontrib>Irusen, Elvis M</creatorcontrib><creatorcontrib>Weinberg, Eugene</creatorcontrib><title>Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS.
Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of √postmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed.
Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval: 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity <80% was associated with HPAS (odds ratio = 4.1 [95% confidence interval: 1.0-14.8]). Daily ICS + NS/m(2) dose was correlated with the postmetyrapone ACTH (r = -0.29, P < .001). BMI (P = .048) and percent adherence to ICS (P < .001) and NS (P = .002) were predictive of √postmetyrapone ACTH (R(2) = .176).
Two-thirds of children on corticosteroids may have hypothalamic-pituitary-adrenal axis dysfunction. In one-third, central function had recovered but adrenal suppression persisted. Predictive factors for HPAS are NS use, BMI, and adherence to ICS and NS.</description><subject>Administration, Inhalation</subject><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Adrenal insufficiency</subject><subject>Adrenal Insufficiency - blood</subject><subject>Adrenal Insufficiency - chemically induced</subject><subject>Adrenocorticotropic Hormone - blood</subject><subject>Anti-Asthmatic Agents - administration & dosage</subject><subject>Anti-Asthmatic Agents - adverse effects</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Anti-Inflammatory Agents - adverse effects</subject><subject>Asthma - drug therapy</subject><subject>Asthma - physiopathology</subject><subject>Asthma in children</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood asthma</subject><subject>Children & youth</subject><subject>Company distribution practices</subject><subject>Correlation analysis</subject><subject>Cortodoxone - blood</subject><subject>Cross-Sectional Studies</subject><subject>Demographic aspects</subject><subject>Distribution</subject><subject>Female</subject><subject>Hormones</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Hypopituitarism - blood</subject><subject>Hypopituitarism - chemically induced</subject><subject>Hypopituitarism - epidemiology</subject><subject>Hypothalamic Diseases - blood</subject><subject>Hypothalamic Diseases - chemically induced</subject><subject>Hypothalamic Diseases - epidemiology</subject><subject>Hypothalamic-pituitary-adrenal axis</subject><subject>Hypothalamo-Hypophyseal System - drug effects</subject><subject>Hypothalamo-Hypophyseal System - physiopathology</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Medication Adherence</subject><subject>Metered Dose Inhalers</subject><subject>Metyrapone</subject><subject>Pediatrics</subject><subject>Physiological aspects</subject><subject>Pilot Projects</subject><subject>Pituitary gland</subject><subject>Pituitary-Adrenal System - drug effects</subject><subject>Pituitary-Adrenal System - physiopathology</subject><subject>Predictive Value of Tests</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0U1P3DAQBmCrApXl49pjFYkLFy8z_kpyRCsolVbiAmfL63hZIydOY0eCf19HS3vgNJfHr2b8EvIDYY1SsNvRdWnNABlFFPU3skJoGypYLU_ICoAjFQDyjJyn9AYAQtbsOzljvOC2gRXZPn6MMR9MML23dPR59tlMH9R0kxtMqMy7T1Wax3FyKfk4VH6oTMqH3mRvq2QPMYbKHnxY_CU53ZuQ3NXnvCAvD_fPm0e6ffr1e3O3pZYrzNSaruMdqs5yx0StFCKYWhgUViHDxjS8hTKkYqyRst3tkbNipLVKQrPjF-TmmDtO8c_sUta9T9aFYAYX56SRlRQJ0KhCr7_QtzhP5bKjwlrIlhdFj-rVBKf9YOOQ3Xu2MQT36nRZfvOk73gJ5YBKFL8-ejvFlCa31-Pk-_JvGkEvveilF730opdeyoOfn2vMu951__m_IvhfiziG4Q</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Zöllner, Ekkehard Werner</creator><creator>Lombard, Carl J</creator><creator>Galal, Ushma</creator><creator>Hough, F Stephen</creator><creator>Irusen, Elvis M</creator><creator>Weinberg, Eugene</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20121201</creationdate><title>Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children</title><author>Zöllner, Ekkehard Werner ; Lombard, Carl J ; Galal, Ushma ; Hough, F Stephen ; Irusen, Elvis M ; Weinberg, Eugene</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-cadd3d16dc3e24766110a74a14c61218a839018a56228559bf1321105cc6508b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Administration, Inhalation</topic><topic>Adolescent</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Adrenal insufficiency</topic><topic>Adrenal Insufficiency - blood</topic><topic>Adrenal Insufficiency - chemically induced</topic><topic>Adrenocorticotropic Hormone - blood</topic><topic>Anti-Asthmatic Agents - administration & dosage</topic><topic>Anti-Asthmatic Agents - adverse effects</topic><topic>Anti-Inflammatory Agents - administration & dosage</topic><topic>Anti-Inflammatory Agents - adverse effects</topic><topic>Asthma - drug therapy</topic><topic>Asthma - physiopathology</topic><topic>Asthma in children</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Childhood asthma</topic><topic>Children & youth</topic><topic>Company distribution practices</topic><topic>Correlation analysis</topic><topic>Cortodoxone - blood</topic><topic>Cross-Sectional Studies</topic><topic>Demographic aspects</topic><topic>Distribution</topic><topic>Female</topic><topic>Hormones</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Hypopituitarism - blood</topic><topic>Hypopituitarism - chemically induced</topic><topic>Hypopituitarism - epidemiology</topic><topic>Hypothalamic Diseases - blood</topic><topic>Hypothalamic Diseases - chemically induced</topic><topic>Hypothalamic Diseases - epidemiology</topic><topic>Hypothalamic-pituitary-adrenal axis</topic><topic>Hypothalamo-Hypophyseal System - drug effects</topic><topic>Hypothalamo-Hypophyseal System - physiopathology</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Medication Adherence</topic><topic>Metered Dose Inhalers</topic><topic>Metyrapone</topic><topic>Pediatrics</topic><topic>Physiological aspects</topic><topic>Pilot Projects</topic><topic>Pituitary gland</topic><topic>Pituitary-Adrenal System - drug effects</topic><topic>Pituitary-Adrenal System - physiopathology</topic><topic>Predictive Value of Tests</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zöllner, Ekkehard Werner</creatorcontrib><creatorcontrib>Lombard, Carl J</creatorcontrib><creatorcontrib>Galal, Ushma</creatorcontrib><creatorcontrib>Hough, F Stephen</creatorcontrib><creatorcontrib>Irusen, Elvis M</creatorcontrib><creatorcontrib>Weinberg, Eugene</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zöllner, Ekkehard Werner</au><au>Lombard, Carl J</au><au>Galal, Ushma</au><au>Hough, F Stephen</au><au>Irusen, Elvis M</au><au>Weinberg, Eugene</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>130</volume><issue>6</issue><spage>e1512</spage><epage>e1519</epage><pages>e1512-e1519</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS.
Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of √postmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed.
Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval: 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity <80% was associated with HPAS (odds ratio = 4.1 [95% confidence interval: 1.0-14.8]). Daily ICS + NS/m(2) dose was correlated with the postmetyrapone ACTH (r = -0.29, P < .001). BMI (P = .048) and percent adherence to ICS (P < .001) and NS (P = .002) were predictive of √postmetyrapone ACTH (R(2) = .176).
Two-thirds of children on corticosteroids may have hypothalamic-pituitary-adrenal axis dysfunction. In one-third, central function had recovered but adrenal suppression persisted. Predictive factors for HPAS are NS use, BMI, and adherence to ICS and NS.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>23147980</pmid><doi>10.1542/peds.2012-1147</doi></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Administration, Inhalation Adolescent Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - adverse effects Adrenal insufficiency Adrenal Insufficiency - blood Adrenal Insufficiency - chemically induced Adrenocorticotropic Hormone - blood Anti-Asthmatic Agents - administration & dosage Anti-Asthmatic Agents - adverse effects Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - adverse effects Asthma - drug therapy Asthma - physiopathology Asthma in children Child Child, Preschool Childhood asthma Children & youth Company distribution practices Correlation analysis Cortodoxone - blood Cross-Sectional Studies Demographic aspects Distribution Female Hormones Humans Hydrocortisone - blood Hypopituitarism - blood Hypopituitarism - chemically induced Hypopituitarism - epidemiology Hypothalamic Diseases - blood Hypothalamic Diseases - chemically induced Hypothalamic Diseases - epidemiology Hypothalamic-pituitary-adrenal axis Hypothalamo-Hypophyseal System - drug effects Hypothalamo-Hypophyseal System - physiopathology Linear Models Male Medical treatment Medication Adherence Metered Dose Inhalers Metyrapone Pediatrics Physiological aspects Pilot Projects Pituitary gland Pituitary-Adrenal System - drug effects Pituitary-Adrenal System - physiopathology Predictive Value of Tests |
| title | Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children |
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