ArticleArchives of disease in childhood2006
Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone.
Article in Archives of disease in childhood, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Fluticasone versus beclomethasone or budesonide for chronic asthma in adults and children.The Cochrane database of systematic reviews · 2007Pooled it
- Glucocorticoid treatment and adrenal suppression in children: current view and open issues.Journal of endocrinological investigation · 2025Review
- Long-Term Usage of Oral Glucocorticoids Leading to Adrenal Insufficiency: A Comprehensive Review of the Literature.Cureus · 2023Review
- Platelet-derived growth factor D expression in adrenal cells is modulated by corticosteroids: putative role in adrenal suppression.Pediatric research · 2023Article
- Baseline and Peak Cortisol Response to the Low-Dose Short Synacthen Test Relates to Indication for Testing, Age, and Sex.Journal of the Endocrine Society · 2022Article
- Screening practices for paediatric asymptomatic adrenal suppression in Canada: Are we addressing this important risk?Paediatrics & child health · 2020Article
- Chronic Corticosterone Treatment During Adolescence Has Significant Effects on Metabolism and Skeletal Development in Male C57BL6/N Mice.Endocrinology · 2017Article
- Recovery of hypothalamo-pituitary-adrenal axis suppression during treatment with inhaled corticosteroids for childhood asthma.Journal of asthma and allergy · 2017Article
- CSACI position statement: systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2015Article
- When will research measure up to our need to know how steroids affect childhood growth?The Cochrane database of systematic reviews · 2014Article
- Iatrogenic Cushing's syndrome with inhaled steroid plus antidepressant drugs.Multidisciplinary respiratory medicine · 2012Article
- Cost considerations of therapeutic options for children with asthma.Paediatric drugs · 2012Article
- Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2011Article
- Adrenal suppression: An under-recognized complication of a common therapy.Paediatrics & child health · 2010Article
- Acute adrenal crisis in an asthmatic child treated with inhaled fluticasone proprionate.International journal of pediatric endocrinology · 2010Article
- Outcomes in clinical trials of inhaled corticosteroids for children with asthma are narrowly focussed on short term disease activity.PloS one · 2009Review
- Corticosteroid physiology and principles of therapy.Indian journal of pediatrics · 2008Article
- What is new in the management of childhood asthma?Indian journal of pediatrics · 2008Review
- Inhaled corticosteroids and adrenal insufficiency: prevalence and clinical presentation.Drug safety · 2008Article
- Compliance with inhaled corticosteroids is important when considering adrenal suppression.Archives of disease in childhood · 2007Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsClinical adrenal insufficiency has been reported with doses of inhaled fluticasone proprionate (FP) > 400 microg/day, the maximum dose licensed for use in children with asthma. Following two cases of serious adrenal insufficiency (one fatal) attributed to FP, adrenal function was evaluated in children receiving FP outwith the licensed dose.
methodsChildren recorded as prescribed FP > or = 500 microg/day were invited to attend for assessment. Adrenal function was measured using the low dose Synacthen test (500 ng/1.73 m2 intravenously) and was categorised as: biochemically normal (peak cortisol response > 500 nmol/l); impaired (peak cortisol < or = 500 nmol/l); or flat (peak cortisol < or = 500 nmol/l with increment of < 200 nmol/l and basal morning cortisol < 200 nmol/l).
resultsA total of 422 children had been receiving FP alone or in combination with salmeterol; 202 were not investigated (137 FP within license; 24 FP discontinued); 220 attended and 217 (age 2.6-19.3 years) were successfully tested. Of 194 receiving FP > or = 500 microg/day, six had flat responses, 82 impaired responses, 104 were normal, and in 2 the LDST was unsuccessful. Apart from the index child, the other five with flat responses were asymptomatic; a further child with impairment (peak cortisol 296 nmol/l) had encephalopathic symptoms with borderline hypoglycaemia during an intercurrent illness. The six with flat responses and the symptomatic child were all receiving FP doses of > or = 1000 microg/day.
conclusionOverall, flat adrenal responses in association with FP occurred in 2.8% of children tested, all receiving > or = 1000 microg/day, while impaired responses were seen in 39.6%. Children on above licence FP doses should have adrenal function monitoring as well as a written plan for emergency steroid replacement.
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