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Long-term treatment with corticosteroids/ACTH in asthmatic children. II. Hypothalamic-pituitary-adrenal function
Insights
Depot tetracosactrin offers a safer alternative for treating severe childhood asthma compared to oral prednisolone. It effectively maintains hypothalamic-pituitary-adrenal (HPA) axis function, unlike prednisolone which can impair it.
Area of Science:
- Pediatric Endocrinology
- Pulmonology
- Pharmacology
Background:
- Severe bronchial asthma in children often requires long-term corticosteroid treatment.
- Assessing the impact of treatments on the hypothalamic-pituitary-adrenal (HPA) axis is crucial for pediatric patients.
Purpose of the Study:
- To evaluate the effects of long-term prednisolone and depot tetracosactrin (ACTH1-24) on HPA axis function in children with severe asthma.
- To compare the safety and efficacy of these treatments regarding HPA axis suppression.
Main Methods:
- Studied 23 children with severe asthma using ACTH stimulation tests and insulin tolerance tests.
- Measured cortisol and growth hormone levels during and after treatment with prednisolone and/or depot tetracosactrin.
Main Results:
- Depot tetracosactrin treatment maintained normal cortisol levels and showed an enhanced ACTH response.
- Prednisolone treatment significantly impaired adrenocortical function, especially in younger children and with higher doses.
- HPA function recovered after switching to depot tetracosactrin; growth hormone levels remained normal.
Conclusions:
- Long-term depot tetracosactrin treatment has minimal HPA axis suppressive side effects in children with severe asthma.
- Depot tetracosactrin is a viable and safer alternative to oral prednisolone for managing severe pediatric asthma.
Abstract:
Hypothalamic-pituitary-adrenal (HPA) function was studied in 23 children with severe bronchial asthma during and after long-term treatment with prednisolone and/or ACTH1-24 depot tetracosactrin) by means of ACTH stimulation test and insulin tolerance test. In the 14 children primarily treated with depot tetracosactrin, the cortisol levels in insulin tests were within normal limits both during and after treatment. An enhanced response to ACTH stimulation was found during the treatment period. During treatment with prednisolone a marked impairment of the adrenocortical function was found, with low basal plasma cortisol levels and subnormal response to ACTH stimulation, more marked the lower the age at the start of treatment and the higher the dose per kg body weight. After substitution with depot tetracosactrin the HPA-function was restituted, with plasma cortisol levels within normal limits. Growth hormone levels after insulin induced hypoglycemia were greater than or equal to 7 ng/ml during and after treatment with depot tetracosactrin. As long-term treatment with depot tetracosactrin has little side-effects in terms of suppression of the HPA-axis it is a useful alternative to oral prednisolone in severe asthma in children.