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Cortisol suppression as a surrogate marker for inhaled corticosteroid-induced growth retardation in children

Jian Xu1, Sreedharan Nair Sabarinath, Hartmut Derendorf

  • 1Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA.

European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences
|November 26, 2008
PubMed

Insights

Inhaled corticosteroids (ICSs) can cause growth inhibition in children. This study found that cumulative cortisol suppression (CCS%) accurately predicts ICS-related growth retardation in pediatric asthma patients.

Area of Science:

  • Pediatric Endocrinology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Inhaled corticosteroids (ICSs) are standard asthma treatment in children.
  • ICS use is associated with adrenal suppression and growth inhibition.
  • The precise relationship between these effects requires further elucidation.

Purpose of the Study:

  • To assess the relationship between ICS-induced growth retardation and cortisol suppression in pediatric asthma.
  • To develop a predictive model for growth velocity based on cortisol suppression.

Main Methods:

  • A meta-analysis of 33 published studies was conducted.
  • Growth velocity (GV) and cumulative cortisol suppression within 24h (CCS%) data were extracted.
  • A linear mixed-effects model was developed to analyze the GV-CCS% relationship.

Main Results:

  • A significant inverse relationship was found between GV and CCS%.
  • The model estimated a -0.06 cm/year/CCS% change in GV.
  • Stadiometry-derived GV was higher than knemometry-derived GV without cortisol suppression.

Conclusions:

  • Cumulative cortisol suppression (CCS%) is a strong predictor of inhaled corticosteroid-mediated growth retardation in children with asthma.
  • The findings support monitoring cortisol suppression to manage growth effects in pediatric ICS users.

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