Long-Term Cortisol Concentration in Scalp Hair of Asthmatic Children Using Inhaled Corticosteroids: A Case-Control Study

Overview

Journal Horm Res Paediatr

Publisher Karger

Specialties Endocrinology
Pediatrics

Date 2017 Jul 18

PMID 28715822

Citations 4

Authors

Maaike P Smit

Ed H G van Leer

Gerard Noppe

Yolanda B de Rijke

Dieneke Kramer van Driel

Erica L T van den Akker

Affiliations

Soon will be listed here.

Abstract

Introduction: Inhaled corticosteroids (ICS) can interfere with the hypothalamic-pituitary-adrenal (HPA) axis and may lead to adrenal insufficiency, resulting in a decrease of cortisol production. Cortisol levels measured in scalp hair provide a marker for long-term cortisol exposure. Data regarding hair cortisol concentration (HCC) in asthmatic children with ICS therapy are scarce. The aim of this study is to compare HCC in asthmatic children under ICS treatment with a healthy control group.

Methods: We set up a case-control study measuring the cortisol concentration in scalp hair in asthmatic children (N = 80) treated with ICS and healthy controls (N = 252) aged 4-18 years. Anthropometric characteristics and hair samples from the posterior vertex were obtained. At least 5 mg of the most proximal 3 cm of hair was used for each hair sample. HCC was analyzed by liquid chromatography-tandem mass spectrometry.

Results: HCC did not significantly differ between asthmatic children using ICS and healthy controls (p = 0.950) after adjustment for age, gender, height, body mass index, and socioeconomic status. No correlation was found between budesonide dosage and HCC levels (r = -0.031, p = 0.78).

Conclusion: There was no evidence of suppression of basal cortisol production, as measured in scalp hair, in asthmatic children using ICS, compared to healthy controls. No conclusions can be drawn on the HPA-axis stress response in these children.

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References

Noppe G, van Rossum E, Koper J, Manenschijn L, Bruining G, de Rijke Y . Validation and reference ranges of hair cortisol measurement in healthy children. Horm Res Paediatr. 2014; 82(2):97-102. DOI: 10.1159/000362519. View

Sauve B, Koren G, Walsh G, Tokmakejian S, van Uum S . Measurement of cortisol in human hair as a biomarker of systemic exposure. Clin Invest Med. 2007; 30(5):E183-91. DOI: 10.25011/cim.v30i5.2894. View

Issa-El-Khoury K, Kim H, Chan E, Leek T, Noya F . CSACI position statement: systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma. Allergy Asthma Clin Immunol. 2015; 11(1):9. PMC: 4369840. DOI: 10.1186/s13223-015-0075-z. View

Bailey D, Colantonio D, Kyriakopoulou L, Cohen A, Chan M, Armbruster D . Marked biological variance in endocrine and biochemical markers in childhood: establishment of pediatric reference intervals using healthy community children from the CALIPER cohort. Clin Chem. 2013; 59(9):1393-405. DOI: 10.1373/clinchem.2013.204222. View

Mosteller R . Simplified calculation of body-surface area. N Engl J Med. 1987; 317(17):1098. DOI: 10.1056/NEJM198710223171717. View

Todd G, Acerini C, Ross-Russell R, Zahra S, Warner J, McCance D . Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child. 2002; 87(6):457-61. PMC: 1755820. DOI: 10.1136/adc.87.6.457. View

Grossman A, Johannsson G, Quinkler M, Zelissen P . Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe. Eur J Endocrinol. 2013; 169(6):R165-75. PMC: 3805018. DOI: 10.1530/EJE-13-0450. View

Fredriks A, Buuren S, Burgmeijer R, Meulmeester J, Beuker R, Brugman E . Continuing positive secular growth change in The Netherlands 1955-1997. Pediatr Res. 2000; 47(3):316-23. DOI: 10.1203/00006450-200003000-00006. View

Cavkaytar O, Vuralli D, Arik Yilmaz E, Buyuktiryaki B, Soyer O, Sahiner U . Evidence of hypothalamic-pituitary-adrenal axis suppression during moderate-to-high-dose inhaled corticosteroid use. Eur J Pediatr. 2015; 174(11):1421-31. DOI: 10.1007/s00431-015-2610-9. View

10.

Kamps A, Molenmaker M, Kemperman R, van der Veen B, Bocca G, Veeger N . Children with asthma have significantly lower long-term cortisol levels in their scalp hair than healthy children. Acta Paediatr. 2014; 103(9):957-61. DOI: 10.1111/apa.12685. View

11.

Dahl R . Systemic side effects of inhaled corticosteroids in patients with asthma. Respir Med. 2006; 100(8):1307-17. DOI: 10.1016/j.rmed.2005.11.020. View

12.

DAnna-Hernandez K, Ross R, Natvig C, Laudenslager M . Hair cortisol levels as a retrospective marker of hypothalamic-pituitary axis activity throughout pregnancy: comparison to salivary cortisol. Physiol Behav. 2011; 104(2):348-53. PMC: 3118940. DOI: 10.1016/j.physbeh.2011.02.041. View

13.

Zollner E, Lombard C, Galal U, Hough F, Irusen E, Weinberg E . Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children. Pediatrics. 2012; 130(6):e1512-9. DOI: 10.1542/peds.2012-1147. View

14.

Karlen J, Frostell A, Theodorsson E, Faresjo T, Ludvigsson J . Maternal influence on child HPA axis: a prospective study of cortisol levels in hair. Pediatrics. 2013; 132(5):e1333-40. DOI: 10.1542/peds.2013-1178. View

15.

Bacharier L, Raissy H, Wilson L, McWilliams B, Strunk R, Kelly H . Long-term effect of budesonide on hypothalamic-pituitary-adrenal axis function in children with mild to moderate asthma. Pediatrics. 2004; 113(6):1693-9. DOI: 10.1542/peds.113.6.1693. View

16.

Muley P, Shah M, Muley A . Safety of inhaled fluticasone propionate therapy for pediatric asthma - a systematic review. Curr Drug Saf. 2013; 8(3):186-94. DOI: 10.2174/15748863113089990038. View

17.

Ribeiro L . Budesonide: safety and efficacy aspects of its long-term use in children. Pediatr Allergy Immunol. 1993; 4(2):73-8. DOI: 10.1111/j.1399-3038.1993.tb00070.x. View

18.

Noppe G, de Rijke Y, Dorst K, van den Akker E, van Rossum E . LC-MS/MS-based method for long-term steroid profiling in human scalp hair. Clin Endocrinol (Oxf). 2015; 83(2):162-6. DOI: 10.1111/cen.12781. View

19.

Mahachoklertwattana P, Sudkronrayudh K, Direkwattanachai C, Choubtum L, Okascharoen C . Decreased cortisol response to insulin induced hypoglycaemia in asthmatics treated with inhaled fluticasone propionate. Arch Dis Child. 2004; 89(11):1055-8. PMC: 1719701. DOI: 10.1136/adc.2002.020560. View

20.

Nagakura T, Tanaka T, Arita M, Nishikawa K, Shigeta M, Wada N . Salivary cortisol monitoring: determination of reference values in healthy children and application in asthmatic children. Allergy Asthma Proc. 2012; 33(4):362-9. DOI: 10.2500/aap.2012.33.3578. View