Secondary adrenal insufficiency with long-term inhaled corticosteroids therapy in asthmatic children

Abstract

<b>Background:</b> Secondary adrenal insufficiency, a potentially serious adverse effect, has been reported with long-term inhaled corticosteroid (ICS) therapy. There is a paucity of such information in children. <b>Aim and Objectives:</b> To assess secondary adrenal insufficiency with long-term ICS therapy in asthmatic children. <b>Method:</b> In this cross-sectional study, children (5-18 years) with diagnosed asthma and ICS therapy for ≥ 6 months were enrolled. In step one, 8 AM fasting serum cortisol samples were taken. In the second step, an ACTH stimulation test with 250 mcg synthetic ACTH (Acton Prolongatum®) was performed in children with fasting cortisol &lt;15mcg/dl. Post-stimulation serum cortisol &lt;18 mcg/dL were considered adrenal insufficiency. <b>Results:</b> A total of 81 children (55% boys), median age 11.5(8, 14) years, were enrolled; three were excluded. Asthma was well-controlled in 56 (71.8%) children, while partly or poorly controlled in 22(28.2%). The median serum cortisol level was 8.32 (5.25, 15.2) mcg/dl; 59 (75.6%) children had cortisol level &lt;15 mcg/dl. ACTH stimulation test was performed in 54 (66.6%) children. The median post-stimulation serum cortisol levels were 22.45 (20.65, 25.45) mcg/dl. Post-stimulation S. cortisol level &lt; 18 mcg/dl was observed in 4/78 (5.1%) children. There was statistically no significant association of post-stimulation cortisol level with ICS dosage (p=0.23), duration (p=0.83), and asthma control (p=0.67). <b>Conclusion:</b> In this study, the prevalence of secondary adrenal insufficiency with long-term ICS therapy was low, and it was not associated with ICS dosage, duration, and asthma control.