Ghanny Steven, Aisenberg Javier E, Heinemann Joseph, Ten Svetlana, Bhangoo Amrit
Pediatric Endocrinology, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
Pediatric Endocrinology, Sinai Hospital, Baltimore, MD 21215, USA.
JCEM Case Rep. 2025 Mar 17;3(4):luaf039. doi: 10.1210/jcemcr/luaf039. eCollection 2025 Apr.
Children with moderate to severe asthma are treated with inhaled corticosteroids (ICS). Altered glucocorticoid sensitivity can cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis in patients on ICS therapy. Our objective is to study glucocorticoid sensitivity in patients with asthma with suppressed HPA axes on ICS. We report 3 patients with suppressed HPA axes on ICS treatment and healthy controls. All subjects and controls underwent glucocorticoid sensitivity analysis using an in vitro fluorescein labeled-dexamethasone (F-DEX) mononuclear cell binding assay. Glucocorticoid sensitivity index (GCSI) was calculated as the area under the curve of the F-DEX assay results. Patients with GCSI ≤264 were classified as glucocorticoid resistant and those with GCSI ≥386 were classified as having increased glucocorticoid sensitivity. All 3 patients were found to have increased glucocorticoid sensitivity with GCSI of 424.9, 720.6, and 699.2 respectively. In conclusion, ICS therapy can lead to HPA axis suppression with varying degrees of adrenal insufficiency and therefore increased glucocorticoid sensitivity should be considered in such cases.
中重度哮喘患儿采用吸入性糖皮质激素（ICS）治疗。糖皮质激素敏感性改变可导致接受ICS治疗的患者下丘脑-垂体-肾上腺（HPA）轴受到抑制。我们的目的是研究ICS治疗下HPA轴受抑制的哮喘患者的糖皮质激素敏感性。我们报告了3例接受ICS治疗且HPA轴受抑制的患者以及健康对照。所有受试者和对照均采用体外荧光素标记地塞米松（F-DEX）单核细胞结合试验进行糖皮质激素敏感性分析。糖皮质激素敏感性指数（GCSI）计算为F-DEX试验结果曲线下面积。GCSI≤264的患者被归类为糖皮质激素抵抗，GCSI≥386的患者被归类为糖皮质激素敏感性增加。发现所有3例患者的糖皮质激素敏感性均增加，GCSI分别为424.9、720.6和699.2。总之，ICS治疗可导致HPA轴抑制并伴有不同程度的肾上腺功能不全，因此在这种情况下应考虑糖皮质激素敏感性增加。
