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Endogenous Glucocorticoid Response to Single-Dose Dexamethasone for Croup in Children: A Pharmacodynamic Study

Natasha Gill1,2, Natalie Sirizzotti1,2, David Johnson3

  • 1From the Children's Hospital, London Health Sciences Centre.

Pediatric Emergency Care
|April 12, 2017
PubMed

Insights

Single-dose oral dexamethasone for croup in children does not suppress endogenous corticosteroid levels. This common treatment for croup in children is not associated with adrenal insufficiency.

Area of Science:

  • Pediatric Endocrinology
  • Pharmacodynamics
  • Clinical Pharmacology

Background:

  • Dexamethasone is linked to adrenal insufficiency in children with chronic conditions.
  • Single-dose oral dexamethasone is the standard treatment for pediatric croup.
  • The impact of single-dose dexamethasone on adrenal function in croup is not well-established.

Purpose of the Study:

  • To investigate the association between single-dose oral dexamethasone and endogenous glucocorticoid levels in children with croup.
  • To test the hypothesis that dexamethasone causes a transient decrease in glucocorticoids.

Main Methods:

  • A prospective, two-arm pharmacodynamic study was conducted.
  • Participants included children over 2 years old with croup receiving dexamethasone and controls with upper respiratory infections.
  • The primary outcome measured was the urinary 6β-hydroxycortisol-cortisol ratio.

Main Results:

  • No significant differences in the change of 6β-hydroxycortisol-cortisol ratios were observed between the dexamethasone and control groups at any time point.
  • Median ratios in the dexamethasone group were 2.8 (baseline), 2.2 (morning), 2.0 (day 1), 2.8 (day 3), and 2.6 (day 7).
  • No serious adverse events or infectious complications were reported.

Conclusions:

  • Single-dose oral dexamethasone is not associated with decreased endogenous corticosteroid levels in children with croup.
  • Further research using criterion standard tests is recommended to definitively rule out hypothalamic-pituitary-adrenal axis suppression.
  • Future studies should also be adequately powered to detect adverse clinical outcomes.
Abstract

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