Adrenal Reserved Function In Asthmatic Children Treated With Inhaled Fluticasone
Mahidol University Annual Research Abstracts 2000 129 We studied 19 patients with thalassemia diseases (TD) and 20 children with thalassemic traits (TT). Mean bone age SDS was -2.73 (range -4.75 to 0.28) in TD whereas that in TT was -0.97 (range -3.77 to 1.59). Bone mineral density (BMD) was determined by dual x-ray absorptiometry (DEXA). In TD, median radius, femoral neck, and lumbar BMD SDS were -0.85, -1.44 and -3.15, respectively whereas in TT, those were within +1.
Anterior iliac bone biopsy was performed for evaluation of histology and histomorphometry. Bone histology revealed increased osteoid thickness and iron deposit in trabecular surface, cement lines and calcification fronts. Osteoclasts and erosion surface were rarely seen in bone sections.
In conclusion, delayed bone age and reduced BMD were common findings in thalassemic bones. Bone histology demonstrated iron deposit, thick osteoid and reduced erosion surface. These findings suggest that there may be delayed bone mineralization and reduced bone resorption in thalassemic bones. Evaluation of bone histomorphometry is required to support these findings. However, the cellular interactions among hematopoietic and bone cells are not yet known and being studied.ADRENAL RESERVED FUNCTION IN ASTHMATIC CHILDREN TREATED WITH INHALED FLUTICASONE Mahachoklertwattana P1, Sudkronrayudh K1, Direkwattanachai C1, Choubtum L2 1Department of Pediatrics, 2Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Background : Cortisol is an essential endogenous steroid. It affects the metabolism of most tissues. Cortisol synthesis is regulated primarily by pituitary corticotropin (ACTH), with cortisol exerting negative feedback on ACTH secretion. Exogenous steroid administration can suppress pituitary-adrenal axis. Inhaled steroids are increasingly used in the prophylaxis and treatment of asthmatic attack. Fluticasone is a new potent inhaled synthetic steroid. The systemic side effect of inhaled fluticasone on adrenal reserved function in asthmatic children is not yet well documented.
Objective : To assess adrenal reserved function in asthmatic children treated with inhaled fluticasone. Methods and subjects : Children were diagnosed with asthma by history, physical examination and methacholine challenge test. All were treated with inhaled fluticasone 250-750 mmg/day via standard spacer for 5-16 weeks. Insulin-induced hypoglycemia test (IHT) was performed to assess adrenal reserved function. Criterion for adrenal suppression is a peak serum cortisol of less than 18 mmg/dl.
Results : Eighteen asthmatic children (10 boys, 8 girls) aged 7-17 years (median age 11 years) were taking inhaled fluticasone at the median dose of 477.3 mmg/m2/day. Adrenal suppression was found in 9 children (50%). The median basal and peak serum cortisol of suppressed group were 4.9 and 12.7 mmg/dl, and of non-suppressed group were 8.8 and 20.5 mmg/dl respectively. Seven children in the suppressed group had repeated IHT after reducing the dose of fluticasone. All had normal adrenal reserved function.
Conclusions : Transient adrenal suppression was evident in 50 per cent of asthmatic children treated with approximately 500 mmg/m2/day of inhaled fluticasone. Therefore, evaluation of adrenal function is necessary in children treated with prolonged inhaled fluticasone. In stress situation, to prevent adrenal crisis, treatment with stress dose of glucocorticoid is recommended. (The Endocrine Society of Thailand : Annual Meeting 1998)