BSPED2010 Poster Presentations (1) (59 abstracts)
Adrenal responses to a simplified low dose short synacthen test (LDSST) in children with asthma
K Platt 1 , J Blair 1 , D Lacy 2 , M Peak 1 , J Couriel 1 , P Newland 1 , P Dharmaraj 1 , U Das 1 , M Didi 1 & T Moorcroft 3
1Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; 2Wirral University Teaching Hospital NHS Foundation Trust Merseyside, Wirral, UK; 3Merseyside and North Wales Medicines for Children Local Research Network, Liverpool, UK.
Introduction: Impairment of the hypothalamic–pituitary–adrenal (HPA) axis has been reported widely in children treated with inhaled corticosteroids (ICS). The integrity of HPA axis has been assessed using low (500 ng/1.73 m2 body surface area) and standard (250 mg) dose short synacthen tests (SST). Serum cortisol is measured at 0, 15, 20, 25, 30 and 35 min intervals in the low dose SST (LDSST) and at 0, 30 and 60 min in the standard dose SST (SDSST). The LDSST may be more sensitive: however, the frequency of sampling makes it technically difficult.
Objective: To study cortisol responses to a simplified LDSST.
Methods: Patients with asthma treated with ICS for >3 months underwent a simplified LDSST with sampling at 0, 15, 25 and 35 min. Responses to the LDSST were categorised as normal (peak cortisol ≥500) or impaired (peak cortisol <500).
Results: One hundred and thirty-six patients (79 male) median age 10.7 years (range 5.1–16.7) were studied. Treatment characteristics (drug, median dose and range) were as follows: (1) fluticasone 500 μg (100–2000), N=108 (2) budesonide 800 μg (200–1600), N=20 (3) beclomethasone 400 μg (200–800), N=8. Basal cortisol correlated strongly with peak cortisol (P=0.005). Forty-seven (34.6%) patients (31 male) age 10.5 years (5.1–16.2) had an impaired response including 25/63 (39.7%) of patients treated with fluticasone ≥500 μg/day. Peak cortisol occurred earlier in patients with an impaired response and patients with a normal response were twice as likely to peak at 35 min (15 vs 34%, P=0.019). There was no difference in age, gender or ICS dose between normal and impaired groups.
Conclusion: The frequency of impaired responses to the simplified LDSST is comparable to that reported in similar cohorts of children studied with more intensive sampling. These preliminary data suggest that simplification of the LDSST does not result in significant loss of specificity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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