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Is adrenal suppression in asthmatic children reversible? A case series

dc.contributor.authorZollner, E. W.en_ZA
dc.date.accessioned2019-11-25T12:28:35Z
dc.date.available2019-11-25T12:28:35Z
dc.date.issued2018-06
dc.identifier.citationZollner, E. W. 2018. Is adrenal suppression in asthmatic children reversible? A case series. South African Medical Journal, 108(6):502-505, doi:10.7196/SAMJ.2018.v108i6.13031.
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.2018.v108i6.13031
dc.identifier.urihttp://hdl.handle.net/10019.1/106877
dc.descriptionCITATION: Zollner, E. W. 2018. Is adrenal suppression in asthmatic children reversible? A case series. South African Medical Journal, 108(6):502-505, doi:10.7196/SAMJ.2018.v108i6.13031.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractBackground. Six hypocortisolaemic asthmatic children on steroids given at physiological doses were identified during a previous study. Objectives. To establish whether hypothalamic-pituitary-adrenal axis suppression (HPAS) could be reversed in hypocortisolaemic asthmatic children treated with steroids without sacrificing asthma control. Methods. In this case series, treatment of six hypocortisolaemic patients was modified by introducing steroid-sparing asthma medications. Serum cortisol and repeat overnight metyrapone tests (ONMTPTs) were done until HPAS was reversed in all patients. A retrospective folder review was performed and the following data were extracted: body mass index standard deviation score (BMI SDS), adherence, daily steroid type and dose, treatment modification, serum cortisol, final ONMTPT result and time taken to achieve normalisation. Results. The median serum cortisol level recovered to 311 nmol/L after 0.9 years (median). The ONMTPT normalised within 3.3 years (median). Steroid load decreased from 9.2 to 5.0 hydrocortisone equivalent mg/m2/d (medians), while asthma score improved from 1.42 to 0.85 (medians). Poor adherence was noted in two children before and four after treatment modification. BMI SDS decreased from –0.08 to –0.16 (medians). Conclusions. Hypocortisolaemia and HPAS could be reversed in asthmatic children treated with physiological doses of steroids by reducing steroid load by 40% and supplementing therapy with steroid-sparing medication. Poor adherence may have either contributed to or retarded HPA recovery. Simultaneously, asthma control improved. Confirmation by a prospective study would be ideal, but may not be feasible.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/12307
dc.format.extent4 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Groupen_ZA
dc.subjectAdrenal insufficiencyen_ZA
dc.subjectSteroidsen_ZA
dc.subjectAsthma in childrenen_ZA
dc.subjectPituitary-adrenal function testsen_ZA
dc.titleIs adrenal suppression in asthmatic children reversible? A case seriesen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthor retains copyrighten_ZA


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