Zöllner Ekkehard Werner, Lombard Carl, Galal Ushma, Hough Stephen, Irusen Elvis, Weinberg Eugene
Paediatric Endocrine Unit, Tygerberg Children's Hospital, University of Stellenbosch, Cape Town, South Africa.
J Pediatr Endocrinol Metab. 2011;24(7-8):529-34. doi: 10.1515/jpem.2011.198.
Hypothalamic pituitary adrenal axis suppression (HPAS) when treating asthmatic children with inhaled corticosteroids (ICS) is thought to be rare.
To determine the prevalence of HPAS in asthmatic children treated with ICS and nasal steroids (NS).
Twenty-six asthmatic children were recruited. Clinical features of HPAS, height, weight, height and weight velocity, steroid dose, adherence, symptom control and lung functions were documented. Metyrapone test was performed if the serum cortisol was > 83 nmol/L (> 3 microg/dL).
No child had a serum cortisol < 83 nmol/L (< 3 microg/dL). Prevalence of HPAS was 35 (CI = 17%-56%). Daily NS dose/ m2 and cumulative NS dose/m2 were significantly (p = 0.03) inversely correlated with the post-metyrapone ACTH (r = -0.42 for both). Current ICS dose was not associated with the post-metyrapone ACTH (r = 0). There was a weak correlation with the daily ICS dose/m2 (r = -0.12) and cumulative ICS dose/m2 (r = -0.26).
A third of asthmatic children on ICS and NS develop HPAS. Contributing factors are the use of NS, body size and cumulative dose of ICS.
使用吸入性糖皮质激素（ICS）治疗哮喘儿童时，下丘脑-垂体-肾上腺轴抑制（HPAS）被认为较为罕见。
确定接受ICS和鼻用类固醇（NS）治疗的哮喘儿童中HPAS的患病率。
招募了26名哮喘儿童。记录HPAS的临床特征、身高、体重、身高和体重增长速度、类固醇剂量、依从性、症状控制和肺功能。如果血清皮质醇>83 nmol/L（>3μg/dL），则进行甲吡酮试验。
没有儿童的血清皮质醇<83 nmol/L（<3μg/dL）。HPAS的患病率为35（CI=17%-56%）。每日NS剂量/m²和累积NS剂量/m²与甲吡酮试验后的促肾上腺皮质激素显著负相关（p=0.03，两者r=-0.42）。当前ICS剂量与甲吡酮试验后的促肾上腺皮质激素无关（r=0）。与每日ICS剂量/m²（r=-0.12）和累积ICS剂量/m²（r=-0.26）存在弱相关性。
接受ICS和NS治疗的哮喘儿童中有三分之一会发生HPAS。相关因素包括NS的使用、体型和ICS的累积剂量。
