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Monitoring growth in asthmatic children treated with high dose inhaled glucocorticoids does not predict adrenal

K A Dunlop1, D J Carson, H J Steen

  • 1Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK.

Archives of Disease in Childhood
|July 23, 2004
PubMed

Insights

Routine growth monitoring does not predict adrenal suppression in children on high-dose inhaled glucocorticoids. Both growth and adrenal function require monitoring in these patients.

Area of Science:

  • Pediatric endocrinology
  • Pharmacology

Background:

  • High-dose inhaled glucocorticoids are used to treat childhood asthma and other conditions.
  • Potential side effects include adrenal suppression, a serious condition that can be life-threatening.
  • Routine monitoring of growth is often performed in children using these medications.

Purpose of the Study:

  • To evaluate if monitoring growth (height standard deviation score - HtSDS) can predict adrenal suppression in prepubertal children treated with high-dose inhaled glucocorticoids.
  • To assess the relationship between changes in HtSDS and adrenal function.

Main Methods:

  • Observational study involving 35 prepubertal children (4-10 years) on high-dose inhaled glucocorticoids (≥1000 μg/day) for ≥6 months.
  • Measured changes in HtSDS over 6 and 12 months prior to adrenal function testing.
  • Assessed adrenal suppression using a low-dose tetracosactrin stimulation test (peak cortisol ≤500 nmol/l).

Main Results:

  • The predictive value of decreased HtSDS for adrenal insufficiency was low (Area Under Curve 0.50-0.59).
  • A decrease of -0.5 HtSDS at 12 months showed 13% sensitivity and 95% specificity for adrenal insufficiency.
  • Peak cortisol levels showed poor correlation with HtSDS changes.

Conclusions:

  • Growth monitoring alone is insufficient to identify children at risk of adrenal suppression from high-dose inhaled glucocorticoids.
  • Both growth and adrenal function require regular monitoring in children on these medications.
  • Further research is needed to establish optimal adrenal function monitoring frequency.
Abstract

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