Endocrine Abstracts

Background: Adrenal suppression is a well recognised complication of inhaled corticosteroids. Committee for Safety of Medicines (CSM) guidelines (2006) recommend that children taking high dose inhaled corticosteroids (HDICS) are tested for adrenal insufficiency. Patients requiring steroid replacement require a steroid card and written advice on steroid replacement in acute illness.

Aims: To determine the impact of CSM guidelines on the use of short synacthen test (SST) in asthmatics on HDICS 2) To evaluate the incidence of adrenal suppression in children on HDICS 3) To identify impending adrenal suppression in asthmatics on HDICS by comparing trends in basal plasma cortisol, peak plasma cortisol and plasma ACTH levels with those in non-asthmatics with a normal SST and no underlying pathology (control group).

Methods: Retrospective review of 85 case notes (38 pre- and 47 post-recommendations).

Results: There were 14 requests for SST’s in children on HDICS in 2007–08 compared to 1 SST in 2004–05. Using the criteria of a peak cortisol of <500 nmol/l or an incremental cortisol rise of <200 nmol/l, 5/14 (35%) of the SST’s were abnormal. 4 out of 5 asthmatics with abnormal synacthen tests received higher than recommended doses of inhaled steroids. There was no significant difference in the basal, peak cortisol levels and ACTH levels in the control group compared to asthmatics with a normal SST. All children on HDICS with adrenal insufficiency received corticosteroid replacement but there was no documentation of steroid card provision or written advice.

Conclusion: Current guidelines have resulted in increased monitoring of asthmatics on steroids. The incidence of adrenal suppression in our local population is similar to the studies done previously. We were unable to identify impending adrenal insufficiency in asthmatics with normal SST’s. Clear documentation of patient care still needs to be addressed.