Gangadharan Arundoss, McCoy Paul, Phyo Aye, McGuigan Michael P, Dharmaraj Poonam, Ramakrishnan Renuka, McNamara Paul S, Blair Joanne
Department of Endocrinology.
Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool.
J Asthma Allergy. 2017 Dec 15;10:317-326. doi: 10.2147/JAA.S142874. eCollection 2017.
To describe recovery of adrenal insufficiency in asthmatic children treated with inhaled corticosteroids (ICS) and cortisol replacement therapy.
Retrospective, observational study.
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 nmol/L and/or peak <350 nmol/L). Patients with suboptimal results received hydrocortisone during periods of stress only, and those with abnormal responses received daily hydrocortisone, increased during periods of stress. A total of 73 patients (68%) had ≥2 LDSSTs over 2.2 years (0.2-7.7).
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).
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.
Recovery of adrenal function is common and occurs during continued ICS and cortisol replacement therapy.
描述接受吸入性糖皮质激素（ICS）和皮质醇替代治疗的哮喘儿童肾上腺功能不全的恢复情况。
回顾性观察研究。
共113例患者，男性74例；年龄10.4（3.3 - 16.5）岁；通过低剂量短程辛纳克试验（替可克肽试验，LDSST）检测，倍氯米松等效ICS剂量为800μg（100 - 1000），对这些患者进行了研究。试验结果根据基础和峰值皮质醇浓度分类：“正常”（基础值>100nmol/L，峰值>500nmol/L），“次优”（基础值>100nmol/L，峰值350 - 499nmol/L），“异常”（基础值<100nmol/L和/或峰值<350nmol/L）。结果次优的患者仅在应激期间接受氢化可的松治疗，而反应异常的患者每日接受氢化可的松治疗，并在应激期间增加剂量。共有73例患者（68%）在2.2年（0.2 - 7.7）内进行了≥2次LDSST。
重复LDSST时皮质醇反应的变化（诊断组间的变化，基础和峰值皮质醇差异>15%[2倍批内变异系数]），BMI和身高标准差评分（SDS）的变化。
17例患者（15%）基线测试结果异常，所有这些患者都进行了重复测试。其中13例患者（76%）测试结果改善（6例恢复正常，7例次优），4例（24%）仍异常。54例患者（48%）基线测试结果次优，其中50例（93%）进行了重新测试。重复测试中，36例患者（72%）恢复正常，11例（22%）仍次优，3例（6%）异常。42例患者基线测试结果正常，其中6例患者（14%）进行了重新测试。3例（50%）结果仍正常，2例（33%）次优，1例（17%）异常。33/73（45%）和42/73（57%）的患者基础和峰值皮质醇水平分别升高>15%，14/73（19%）和7/73（10%）的患者分别降低>15%。身高或BMI SDS无显著变化。
肾上腺功能恢复常见，且发生在持续的ICS和皮质醇替代治疗期间。
