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Related Experiment Videos

Adrenal function in acute severe asthma.

N C Karalus, C B Mahood, P J Dunn

    The New Zealand Medical Journal
    |October 9, 1985
    PubMed
    Summary
    This summary is machine-generated.

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    Adrenocortical function is often impaired in patients with severe asthma, particularly those using oral steroids. This adrenal suppression may contribute to mortality in acute asthma cases.

    Area of Science:

    • Endocrinology
    • Pulmonology
    • Pharmacology

    Background:

    • Acute severe asthma is a critical condition requiring prompt management.
    • Adrenocortical function is crucial for stress response and overall homeostasis.
    • Previous studies have suggested a link between corticosteroid use and adrenal suppression, but data in acute severe asthma is limited.

    Purpose of the Study:

    • To assess adrenocortical function in patients with acute severe asthma.
    • To investigate the impact of different corticosteroid regimens on adrenal suppression.
    • To determine if adrenal insufficiency is a significant factor in asthma-related mortality.

    Main Methods:

    • Intravenous short synacthen test (SST) was administered to 68 patients with acute severe asthma and 22 control subjects.

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  • Serum cortisol levels were measured before and after synacthen stimulation to assess cortisol increment.
  • Patients were categorized based on their steroid use (continuous oral, occasional oral, inhaled, or no steroids).
  • Serum dehydroepiandrosterone sulfate (DHEA-SO4) levels were also analyzed.

    • Main Results:

    • Subnormal cortisol increment was observed in 19 of 68 asthmatic patients (28%).
    • Adrenal suppression was most pronounced in patients on continuous oral steroids (11/14) and those on divided daily oral steroid doses (19/43).
    • Patients on inhaled steroids only (1/7) or no steroids (0/18) showed less frequent adrenal suppression.
    • Serum DHEA-SO4 levels were not a reliable indicator of adrenocortical function in this cohort.
    • A significant proportion of patients with low cortisol increments had not received supplementary steroids prior to admission.

    Conclusions:

    • Adrenocortical function is frequently impaired in patients with acute severe asthma, particularly those with a history of oral corticosteroid use.
    • The degree of adrenal suppression correlates with the intensity and duration of oral steroid therapy, especially divided daily doses.
    • Adrenal insufficiency may represent an underrecognized contributor to mortality in patients with acute severe asthma, particularly in regions like New Zealand.