Is
adrenal suppression in asthmatic children reversible?
Corticosteroids are synthetic forms of cortisol.2 They are usually prescribed in a once a day regimen to match the normal circadian rhythm of steroid hormones and to avoid
adrenal suppression.4 Despite being life-saving, steroids have many adverse effects.
Unfortunately, corticosteroids can also cause side effects, one of which is
adrenal suppression, seen in up to 1/3 of people tested.
In a world first, the University of Liverpool researchers, led by Sir Munir Pirmohamed, conducted a genome-wide association study (GWAS) to pinpoint the genes responsible for increasing the risk of a person developing
adrenal suppression.
They might have some value to check the grade of
adrenal suppression they may cause.
Trials on the use of ICSs in CF for the treatment of allergic bronchopulmonary aspergillosis did not systematically evaluate adverse events, although the total daily dose of ICSs was at the threshold of
adrenal suppression in most studies [4].
What many of these cases share is the inhibition of CYP3A4 which results in supraphysiologic levels of corticosteroids (inhaled, intranasal, intra-articular, or oral) leading to iatrogenic Cushing's syndrome with resultant
adrenal suppression. There are also case reports of itraconazole-induced central adrenal insufficiency, but in all cases, it was thought to be due to a drug interaction with inhaled corticosteroids [13, 14].
Suppression of HPA axis is a well-known and tested effect of exogenous therapy with glucocorticoids (GCs) and GC therapy is the most common cause of
adrenal suppression.
The prescribing information says that mometasone furoate exerts less effect on the hypothalamic-pituitary-adrenal axis than other inhaled corticosteroids, and that
adrenal suppression is unlikely to occur when used at recommended dosages.
Patients taking steroids have a significant risk of
Adrenal suppression caused due to suppression of hypothalamic pituitary axis leading to adrenal insufficiency.
Seven studies with a primary end-point of
adrenal suppression performed on 1303 patients were analyzed separately.
Adrenal suppression levels of serum cortisol; taken at 0800 hrs following 3 weeks of treatment, less than 3 ug/dl (83nmol/l) was taken as cases of
adrenal suppression.