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ACTH regulates adrenal androgen production, which may thus be reduced during glucocorticosteroid therapy. Dehydroepiandrosterone sulfate is the most abundant androgen secreted by the adrenals. We wished to evaluate whether serum levels of dehydroepiandrosterone sulfate can be used as an indicator of adrenal suppression during inhaled steroid treatment in children. Sixty school-aged children with newly diagnosed asthma were randomly divided into budesonide (n = 30) and fluticasone propionate (n = 30) groups. Fifteen cromone-treated children served as a control group. The budesonide dose was 800 microg/d during the first 2 months and 400 microg/d thereafter. The respective fluticasone propionate doses were 500 and 200 microg/d. Serum dehydroepiandrosterone sulfate concentrations were measured before and after 2 and 4 months of treatment. In the budesonide group, serum dehydroepiandrosterone sulfate decreased from the baseline by a mean of 21% (95% confidence interval, 13-29%; P < 0.001) after 2 months of high dose treatment and by 16% (95% confidence interval, 8-25%; P < 0.001) after 4 months of treatment. In the fluticasone propionate group, the respective figures were 10% (95% confidence interval, 4-16%; P < 0.01) and 6% (95% confidence interval, 16% decrease-3% increase; P = NS). A low dose ACTH test indicated adrenocortical suppression at 4 months in 14 (23%) steroid-treated children. In these children, dehydroepiandrosterone sulfate decreased by a mean of 21% (95% confidence interval, 14-28%), whereas in those 46 steroid-treated children with normal ACTH test results, dehydroepiandrosterone sulfate decreased by 8% (95% confidence interval, 0-16%; P < 0.05 between these groups). In the control group, dehydroepiandrosterone sulfate levels tended to increase (by a mean of 26%), reflecting the normal physiological change at this age. In conclusion, inhaled steroid treatment suppresses dehydroepiandrosterone sulfate production in a dose-dependent manner. Monitoring of serum dehydroepiandrosterone sulfate concentrations can be used as a practical method to follow adrenocortical function and to detect its suppression during inhaled steroid treatment in children.
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
May 2004,
European journal of endocrinology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
August 2006,
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
September 2004,
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
December 1995,
The Journal of allergy and clinical immunology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
September 2000,
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
January 2001,
Salud publica de Mexico,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
June 1999,
Revue medicale de la Suisse romande,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
January 1981,
Obstetrics and gynecology,
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
September 1996,
Lancet (London, England),
S Kannisto, and
M Korppi, and
K Remes, and
R Voutilainen
September 1996,
Lancet (London, England),
