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The hypothalamic-pituitary-adrenal axis in asthmatic children
Kostas N Priftis1, Anastasios Papadimitriou, Polyxeni Nicolaidou
1Department of Allergy-Pneumonology, Penteli Children's Hospital, Athens, Greece. kpriftis@otenet.gr
Trends in Endocrinology and Metabolism: TEM
|December 25, 2007
Summary
Inhaled corticosteroids (ICS) may improve hypothalamic-pituitary-adrenal (HPA) axis function in asthma patients, despite potential mild adrenal suppression. This suggests ICS benefits extend beyond asthma control to endocrine health.
Area of Science:
- Endocrinology
- Pulmonology
- Immunology
Background:
- Reduced hypothalamic-pituitary-adrenal (HPA) axis responsiveness is observed in chronic allergic inflammation and poorly controlled asthma.
- Pro- and anti-inflammatory cytokines may influence cortisol and adrenocorticotropic hormone (ACTH) responses to stress in these patients.
Purpose of the Study:
- To investigate the impact of long-term inhaled corticosteroids (ICS) on HPA axis function in asthmatic children.
- To explore the relationship between asthma control, HPA axis function, and potential adrenal suppression with ICS therapy.
Main Methods:
- Observational study analyzing HPA axis responsiveness in asthmatic patients before and during long-term ICS treatment.
- Assessment of cortisol and ACTH levels in response to stress.
- Evaluation of asthma control and potential markers of adrenal suppression.
Main Results:
- The majority of asthmatic children showed improvement in HPA axis function with long-term ICS treatment.
- A minority of patients experienced mild adrenal suppression, potentially linked to genetic or constitutional factors.
- ICS treatment correlated with improved asthma remission and enhanced HPA axis function.
Conclusions:
- Long-term ICS therapy can lead to HPA axis improvement in most asthmatic children, alongside asthma remission.
- Adrenal suppression in some patients on maintenance ICS appears to be an independent phenomenon.
- The anti-inflammatory effects of ICS are key to both respiratory and endocrine improvements.
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