Effects of intranasal corticosteroids on the hypothalamic-pituitary-adrenal axis in children
Summary
This summary is machine-generated.Morning plasma cortisol levels are unreliable for detecting adrenal insufficiency in children. The 24-hour integrated concentration plasma cortisol test is preferred for assessing hypothalamic-pituitary-adrenal (HPA) axis suppression in pediatric patients.
Area Of Science
- Pediatric Endocrinology
- Pharmacology
- Hormone Regulation
Background
- Circadian rhythm of cortisol levels differs between adults and children.
- Inhaled corticosteroids can delay peak cortisol levels in children, impacting diagnostic sensitivity.
- Adrenal insufficiency detection in children requires careful consideration of testing methods.
Purpose Of The Study
- To evaluate the effectiveness of different tests for detecting clinically relevant hypothalamic-pituitary-adrenal (HPA) axis suppression in children.
- To assess the impact of intranasal corticosteroids on HPA axis function in pediatric populations.
Main Methods
- Review of literature on HPA axis suppression with various intranasal corticosteroids (budesonide, fluticasone propionate, beclomethasone dipropionate, mometasone furoate).
- Analysis of studies examining urinary and plasma cortisol levels in children and adults.
- Consideration of 24-hour integrated concentration plasma cortisol as a diagnostic tool.
Main Results
- Single morning cortisol tests have low sensitivity for detecting adrenal insufficiency in children.
- Intranasal corticosteroids generally have minimal effect on the HPA axis in children.
- Mometasone furoate showed no HPA axis effects in extensive adult and pediatric trials.
Conclusions
- The 24-hour integrated concentration plasma cortisol test is a suitable, noninvasive method for assessing HPA axis suppression in children.
- Routine monitoring of adrenal function is likely unnecessary for children treated with intranasal corticosteroids.
- Children are not expected to be more sensitive to corticosteroids than adults regarding HPA axis effects.
View abstract on PubMed