Screening for hypothalamic-pituitary-adrenal axis suppression in asthmatic children remains problematic : a cross-sectional study

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dc.contributor.authorZollner, Ekkehard Werneren_ZA
dc.contributor.authorLombard, Carl J.en_ZA
dc.contributor.authorGalal, Ushmaen_ZA
dc.contributor.authorHough, Stephenen_ZA
dc.contributor.authorIrusen, Elvis M.en_ZA
dc.contributor.authorWeinberg, Eugeneen_ZA
dc.date.accessioned2014-07-07T12:28:08Z
dc.date.available2014-07-07T12:28:08Z
dc.date.issued2013
dc.descriptionCITATION: Zollner, E. W. et al. 2013. Screening for hypothalamic-pituitary-adrenal axis suppression in asthmatic children remains problematic : a cross-sectional study. BMJ Open, 3:e002935, doi:10.1136/bmjopen-2013-002935.
dc.descriptionThe original publication is available at http://bmjopen.bmj.com
dc.description.abstractObjective To determine which parameter is the most useful screening test for hypothalamic–pituitary–adrenal suppression in asthmatic children. Design Cross-sectional study. Setting Paediatric allergy clinics in Cape Town, South Africa. Participants 143 asthmatic children of mostly mixed ancestry, aged 5–12 years. Outcome measures Primary outcome measures included Spearman correlation coefficients (r) calculated between the postmetyrapone (PMTP) serum adrenocorticotropic hormone (ACTH), 11-deoxycortisol (11DOC), 11DOC+ cortisol (C) and height, weight, height velocity, weight velocity, change in systolic blood pressure from supine to standing, early morning urinary free cortisol (UFC), morning C, ACTH and dehydroepiandrosterone sulfate (DHEAS). Secondary outcome measures were the receiver operating characteristics (ROC) curve and the diagnostic statistics for the most promising test. Results All screening variables were weakly correlated with the three PMTP outcomes. Only DHEAS and UFC (nmol/m2) were statistically significant—DHEAS for PMTP ACTH and 11DOC (r=0.20, p=0.025 and r=0.21, p=0.017); UFC (nmol/m2) for PMTP 11DOC and 11DOC+C (r=0.19, p=0.033 and r=0.20, p=0.022). The area under ROC curve for DHEAS in the 5-year to 9-year age group was 0.69 (95% CI 0.47 to 0.92). At DHEAS cut-off of 0.2 µmol/L: sensitivity=0.88 (CI 0.47 to 1.00), specificity=0.61 (CI 0.42 to 0.78), positive predictive value=0.37 (CI 0.16 to 0.62), negative predictive value=0.95 (CI 0.75 to 1.00), accuracy=0.67 (CI 0.50 to 0.81), positive likelihood ratio=2.26 (CI 1.35 to 3.78), negative likelihood ratio=0.20 (CI 0.03 to 1.30). Conclusions No parameter is useful as a universal screening test. DHEAS may be suitable to exclude HPAS before adrenarche. Further research is needed to confirm these findings and identify factors, for example, genetic that may predict or protect against HPAS.en_ZA
dc.description.urihttp://bmjopen.bmj.com/content/3/8/e002935
dc.description.versionPublisher's version
dc.format.extent7 pages
dc.identifier.citationZollner, E. W. et al. 2013. Screening for hypothalamic-pituitary-adrenal axis suppression in asthmatic children remains problematic : a cross-sectional study. BMJ Open, 3:e002935, doi:10.1136/bmjopen-2013-002935.
dc.identifier.issn2044-6055 (online)
dc.identifier.otherdoi:10.1136/bmjopen-2013-002935
dc.identifier.urihttp://hdl.handle.net/10019.1/93924
dc.language.isoen
dc.publisherBMJ
dc.rights.holderAuthors retain copyright
dc.subjectAsthma in children -- Medical screeningen_ZA
dc.subjectHypothalamic–pituitary–adrenal axis suppression -- Testingen_ZA
dc.subjectCorticosteroidsen_ZA
dc.subjectDehydroepiandrosterone -- Testingen_ZA
dc.titleScreening for hypothalamic-pituitary-adrenal axis suppression in asthmatic children remains problematic : a cross-sectional studyen_ZA
dc.typeArticle
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