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Hypothalamic-pituitary-adrenal axis in corticosteroid-resistant bronchial asthma
S J Lane1, B A Atkinson, R Swaminathan
1Department of Allergy and Respiratory Medicine, Guy's Hospital, London, United Kingdom.
American Journal of Respiratory and Critical Care Medicine
|February 1, 1996
Summary
Corticosteroid-resistant (CR) asthma does not involve abnormal cortisol secretion or altered hypothalamic-pituitary-adrenal (HPA) axis sensitivity. Standard dexamethasone suppression tests showed no significant differences between CR and corticosteroid-sensitive asthma patients.
Area of Science:
- Endocrinology
- Pulmonology
- Pharmacology
Background:
- Corticosteroid resistance (CR) in bronchial asthma presents a clinical challenge.
- The underlying mechanisms of CR asthma, particularly concerning endogenous cortisol secretion and HPA axis function, remain unclear.
Purpose of the Study:
- To investigate whether CR asthma is associated with abnormalities in endogenous cortisol secretion.
- To assess the sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis to dexamethasone suppression in CR asthma patients.
Main Methods:
- A modified dexamethasone suppression test (DST) was employed in five corticosteroid-sensitive (CS) and five CR asthmatic subjects.
- Subjects received either 0.25 mg or 1 mg of oral dexamethasone on separate occasions.
- Urinary free cortisol, plasma cortisol, and adrenocorticotropic hormone (ACTH) levels were measured using established assays.
Main Results:
- No significant differences in baseline urinary free cortisol, plasma ACTH, or plasma cortisol were observed between CS and CR groups.
- Low-dose (0.25 mg) dexamethasone did not significantly suppress plasma ACTH and cortisol in either group.
- High-dose (1 mg) dexamethasone equally suppressed plasma ACTH and cortisol to undetectable levels in both CS and CR groups.
Conclusions:
- Corticosteroid resistance in bronchial asthma is not linked to altered endogenous cortisol secretory rates.
- The HPA axis sensitivity to dexamethasone suppression is not different between corticosteroid-sensitive and corticosteroid-resistant asthma patients.
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