Assessment of adrenal suppression in children with asthma treated with inhaled corticosteroids: Use of dehydroepiandrosterone sulfate as a screening test

Morna J. Dorsey, Laurie E. Cohen, Wanda Phipatanakul, Danielle Denufrio, Lynda C. Schneider

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background: Inhaled corticosteroids (ICs) are considered first-line therapy for persistent asthma. At medium to high doses, ICs can suppress the hypothalamic-pituitary-adrenal (HPA) axis. Various provocative stimuli have been used to evaluate HPA axis function, but they are labor intensive and time-consuming. Dehydroepiandrosterone sulfate (DHEA-S) is a corticotropin-dependent adrenal androgen precursor that is suppressible in patients treated with ICs. Objectives: To evaluate DHEA-S as a possible marker for HPA axis dysfunction in children treated with ICs. Methods: Children with moderate-to-severe persistent asthma and a history of medium- to high-dose IC exposure for at least 6 months were evaluated using low-dose and standard high-dose cosyntropin stimulation testing to assess adrenal function, and DHEA-S levels were compared with the results. Results: Thirteen (59%) of 22 patients exhibited an abnormal cortisol response to cosyntropin. Age- and sex-specific mean DHEA-S z scores were significantly lower in cosyntropin abnormal responders (-1.2822) compared with normal responders (0.2964) (P = .008). The receiver operating characteristic curve for DHEA-S z scores had an area of 0.786 (95% confidence interval, 0.584-0.989), reaching 100% sensitivity with a DHEA-S z score of -1.5966 or less and 100% specificity with a DHEA-S z score greater than 0.0225. Conclusions: Most children develop biochemical evidence of adrenal suppression after treatment with medium to high doses of ICs. The presence of low DHEA-S levels can be used as a screening test to identify the child who needs more formal testing of the HPA axis.

Original languageEnglish (US)
Pages (from-to)182-186
Number of pages5
JournalAnnals of Allergy, Asthma and Immunology
Volume97
Issue number2
DOIs
StatePublished - Aug 2006
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

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