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Irish Child Health Database - Peer Reviewed Papers

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  • Monitoring Growth in asthmatic children treated with high dose inhaled glucocorticoids does not predict adrenal suppression

    Published in:

    Archives of Disease in Childhood, Vol: 89, Page: 713-716,BMJ Publishing Group

    Aims & Objectives:

    This study examined routine outpatient monitoring of growth predicts adrenal suppression in prepubertal children treated with high dose inhaled glucocorticoid

    Abstract:

    Aims: To determine whether routine outpatient monitoring of growth predicts adrenal suppression in prepubertal children treated with high dose inhaled glucocorticoid. Methods: Observational study of 35 prepubertal children (aged 4-10 years) treated with at least 1000 pg/day of inhaled budesonide or equivalent potency glucocorticoid for at least six months. Main outcome measures were: changes in HtSDS over 6 and 12 month periods preceding adrenal function testing, and increment and peak cortisol after stimulation by iow dose tetracosactrin test. Adrenal suppression was defined as a peak cortisol  500 nmol/l. Results: The areas under the receiver operator characteristic curves for a decrease in HtSDS as a predictor of adrenal insufficiency 6 and 12 months prior to adrenal testing were 0.50 (SE 0.10) and 0.59 (SE 0.10). Prediction values of an HtSDS change of -0.5 for adrenal insufficiency at 12 months prior to testing were: sensitivity 13%, specificity 95%, and positive likelihood ratio of 2.4. Peak cortisol reached correlated poorly with change in HtSDS (p=0.23, p=0.l9 at 6 months; p=0.33, p =0.06 at 12 months). Conclusions: Monitoring growth does not enable prediction of which children treated with high dose inhaled glucocorticoids are at risk of potentially serious adrenal suppression. Both growth and adrenal function should be monitored in patients on high dose inhaled glucocorticoids. Further research is required to determine the optimal frequency of monitoring adrenal function.

    Authors:

    K. A. Dunlop; D. J. Carson; H. J. Steen; V. McGovern; J. McNaboe; M. D. Shields

    Study Type:

    Study Papers » A study of sensitivity and specificity of a measurement tool » Descriptive Studies - Studies with a health technology dimension

    Notes:

    Article 00039888 Accession Number: 14156573; Dunlop, K. A. 1; Carson, D. J. 1; Steen, H. J. 1; McGovern, V. 1; McNaboe, J. 1; Shields, M. D. 1; Email Address: m.shields@qub.ac.uk; Affiliations: 1: Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK. Source Info: Aug2004, Vol. 89 Issue 8, p713; Note: Publisher Information: BMJ Publishing Group.; Subject Term: ASTHMA in children; Subject Term: PEDIATRIC respiratory diseases; Subject Term: ADRENAL glands; Subject Term: ANTI-inflammatory agents; Subject Term: GLUCOCORTICOIDS; Subject Term: HYDROCORTISONE; Number of Pages: 4p. Document Type: Article

    Categories:

    growth monitoring; adrenal suppression; glucocorticoid

    International Classification:

    Diagnostic tool (biological measure) - glucocorticoid measures

    Keywords:


    Geography:

    Northern Ireland (Northern Ireland)