Abstract
Conventional assessment of adrenal function is achieved by measurement of 0800h serum cortisol, 24h urinary cortisol excretion and standard dose (250μg) ACTH(1-24) or insulin tolerance testing. Adrenal function was assessed as part of a growth study in 56 pre-pubertal (age range 4-12 years) children with asthma who were grouped according to treatment. The groups were: 1=non-steroid, n=13; 2=budesonide, n=20; 3=beclomethasone, n=20; prednisolone, n = 3. The mean(SD) dose of inhaled steroid in groups 2 and 3 was similar: 762(525) and 560(281)μg/m2/day respectively, p = 0.15. 31 short normally growing children (Gp5) were used for comparison. Estimates of cortisol secretion were: 24h serum cortisol profile with sampling every 20 min to give mean, peak and 0800h values and in circadian rhythm by analysis of timing of early morning cortisol rise. A 24h urine was collected for total cortisol metabolites. The cortisol response to a low (500ng/1.73m2) and standard (250μg/1.73m2) dose of ACTH(1-24) was assessed by comparison of the rise in and concentration of cortisol at 20 min (low dose) and 60 min (standard dose).
Results: There was no group difference in 0800h cortisol but mean 24h cortisol was lower in Gp2, 3, 4 (p=0.0005). Mean 24h cortisol correlated best with cortisol rise and concentration at 20 min after low dose ACTH (r=0.45, p = 0.002;r=0.55, p<0.0001), time of early morning rise (r=-0.64, p<0.0001) and 0800h cortisol (r = 0.36, p = 0.002) but weakly with urinary cortisol excretion (1=0.29, p=0.08) and cortisol rise and concentration at 60 min after standard dose ACTH (r=0.28, p = 0.3). We conclude that low dose ACTH testing gave the most accurate guide to physiological cortisol secretion as assessed by a 24h profile.
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Crowley, S., Hindmarsh, P., Honour, J. et al. ASSESSMENT OF CORTISOL SECRETION IN CHILDREN WITH ASTHMA TREATED WITH INHALED STEROIDS. Pediatr Res 33 (Suppl 5), S13 (1993). https://doi.org/10.1203/00006450-199305001-00062
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DOI: https://doi.org/10.1203/00006450-199305001-00062