Pijls N H, Driessen M N
Tijdschr Kindergeneeskd. 1985 Apr;53(2):45-9.
The function of the pituitary-adrenal axis was investigated in ten asthmatic children (5-14 years of age) before and after administration of beclomethasone-dipropionate as inhalation therapy in a dose of 300-600 micrograms/24 hrs, during six months. Cortisol diurnal rhythm, excretion of free cortisol in 24 hours urine and stimulation of plasma-cortisol after ACTH-administration were determined. The same investigations were carried out in a comparable group of ten asthmatic children already using this inhalation therapy for more than one year. Significant differences were found comparing 08.00 h. cortisol values of the children from the first group and those who used medication for more than one year. In this first group, the ability of the adrenal glands to be stimulated by ACTH-administration after six months of medication, decreased significantly as well. These results indicate an impairment of the function of pituitary-adrenal axis during long-term treatment with inhaled beclomethasone-dipropionate. This implicates a decreased ability of the adrenal glands to react in an optimum way in stress-situations. In these patients oral or parenteral administrations of steroids should be considered earlier in stress situations like a severe asthma attack.
对10名5至14岁哮喘儿童在为期6个月、以300 - 600微克/24小时剂量吸入丙酸倍氯米松治疗前后的垂体-肾上腺轴功能进行了研究。测定了皮质醇昼夜节律、24小时尿游离皮质醇排泄量以及注射促肾上腺皮质激素（ACTH）后血浆皮质醇的反应。对另一组10名已使用这种吸入疗法一年以上的哮喘儿童进行了同样的研究。比较第一组儿童与使用药物一年以上儿童在上午8点的皮质醇值时发现了显著差异。在第一组中，用药6个月后肾上腺对ACTH注射的反应能力也显著下降。这些结果表明，长期吸入丙酸倍氯米松治疗期间垂体-肾上腺轴功能受损。这意味着肾上腺在应激情况下以最佳方式反应的能力下降。在这些患者中，在严重哮喘发作等应激情况下，应更早考虑口服或胃肠外给予类固醇。
