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Hypothalamic-pituitary-adrenal function in children with asthma and rhinitis treated with topical
1Department of Paediatrics, Randers Hospital, Denmark.
Insights
Topical glucocorticosteroids for children with asthma and rhinitis do not cause clinically significant hypothalamic-pituitary-adrenal (HPA) insufficiency. Sensitive tests may show minor adrenal suppression, but growth suppression is the main concern.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Allergy and Immunology
Background:
- The potential for topical glucocorticosteroids to suppress hypothalamic-pituitary-adrenal (HPA) axis function in children is a significant clinical concern.
- Debate continues regarding the actual risk and clinical relevance of this suppression.
Purpose of the Study:
- To synthesize existing data on HPA axis function in pediatric patients with asthma and rhinitis using topical glucocorticosteroids.
- To evaluate the utility of HPA function assessments in both clinical practice and research settings.
Main Methods:
- A comprehensive review of peer-reviewed scientific literature was conducted.
- Data from studies investigating HPA function in children using topical glucocorticosteroids were analyzed.
Main Results:
- No evidence supports clinically significant HPA insufficiency in children using recommended doses of inhaled or insufflated glucocorticosteroids.
- Sensitive assays revealed suppressive effects on basal adrenal activity with certain drugs, high doses, or specific delivery systems.
- These findings may reflect normal homeostatic adjustments in cortisol production.
Conclusions:
- Clinically significant HPA insufficiency due to recommended topical glucocorticosteroid use in children is not supported by current evidence.
- While sensitive measures can detect minor adrenal suppression, these tests are not recommended for routine management.
- HPA function measures may be valuable in clinical trials to assess the systemic effects of different glucocorticosteroid regimens and devices.
- Growth suppression remains the most critical adverse effect associated with topical glucocorticosteroid use in pediatric populations.
Background:
The risk of suppression of hypothalamic-pituitary-adrenal (HPA) function in children on topical glucocorticosteroids is currently much debated.
Objective:
To review data on HPA function in children with asthma and rhinitis on topical glucocorticosteroids, and to discuss the value of HPA function measures in clinical practice and research.
Method:
A review of peer refereed data.
Results/Conclusions:
There is no evidence that insufflated or inhaled glucocorticosteroids in recommended doses have ever caused clinically significant HPA insufficiency in any child. Using sensitive measures of basal adrenal activity, however, several studies have found suppressive effects with specific drugs, high doses and application systems. These observations may represent homeostatic diminution in endogenous cortisol. Such measures have no place in the management of children on topical glucocorticosteroids, but may be useful in clinical trials assessing systemic activity of administration regimens and application devices. In children growth suppression seems to the most important adverse effect of topical glucocorticosteroids.