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Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids
Thesis (PhD)--Stellenbosch University, 2013.
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| Format: | Thesis |
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Stellenbosch : Stellenbosch University
2013
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| _version_ | 1867613980334227456 |
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| access_status_str | Open Access |
| author | Zollner, Ekkehard Werner Arthur |
| author2 | Hough, F. S. |
| author_browse | Hough, F. S. Zollner, Ekkehard Werner Arthur |
| author_facet | Hough, F. S. Zollner, Ekkehard Werner Arthur |
| author_sort | Zollner, Ekkehard Werner Arthur |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2013. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019/11052 |
| institution | Stellenbosch University (South Africa) |
| last_indexed | 2026-06-10T12:44:45.702Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2013 |
| publishDateRange | 2013 |
| publishDateSort | 2013 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019/11052 Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids Zollner, Ekkehard Werner Arthur Hough, F. S. Irusen, E. M. Stellenbosch University. Faculty of Medicine and Health Sciences. Department of Paediatrics and Child Health. Asthma in children Pituitary hormone releasing factors UCTD Thesis (PhD)--Stellenbosch University, 2013. ENGLISH ABSTRACT: Although the effect of inhaled corticosteroids (ICS) on the hypothalamic- pituitary-adrenal axis (HPA) has been regarded as a “benign physiological response”, a survey published in 2002 suggested that adrenal crisis is more common in asthmatic children on ICS than previously thought. Relying on clinical features to detect chronic adrenal insufficiency secondary to corticosteroids may not be wise, as these are non-specific and can therefore easily be missed. Accurate biochemical assessment of the whole axis to detect subclinical HPA suppression (HPAS) is thus desirable. A review of the literature indicates that basal adrenal function tests, including plasma cortisol profiles, do not identify which children can appropriately respond to stress. There is no evidence to suggest that the degree of the physiological adjustment of the HPA to ICS and/or nasal steroids (by reducing basal cortisol production), predicts HPAS. Cortisol profiles should therefore only be used to demonstrate differences in systemic activity of various ICS and delivery devices. Only two tests, considered as gold standard adrenal function tests [the insulin tolerance test (ITT) and the metyrapone test] can assess the integrity of the whole axis. AFRIKAANSE OPSOMMING: Die outeurs van ´n opname wat in 2002 gepubliseer is stel voor dat ´n bynierkrisis meer algemeen by asmatiese kinders, wat inhalasie kortikosteroïede ontvang, voorkom as wat voorheen gedink is. Dit is strydig met die gevestigde opvatting dat die effek van IKS op die hipotalamiese-hipofise-bynier-as (HHB) ’n “goedaardige fisiologiese reaksie” is. Die kliniese kenmerke van kroniese bynierontoereikendheid sekondêr tot die gebruik van kortikosteroïede (KS) is nie-spesifiek en gevolglik onbetroubaar. ´n Akkurate biochemiese toets van subkliniese HBB onderdrukking (HHBO) sou gevolglik waardevol wees. ´n Literatuur oorsig toon dat toetse van basale bynierfunksie, insluitend plasma kortisol (K) profiele, nie kinders uitken wat toepaslik op stres sal reageer nie. Daar is geen bewyse dat die graad van fisiologiese aanpassing van die HHB, soos aangedui deur laer K-vlakke, na die gebruik van IKS en/of nasale steroïede (NS), HHBO voorspel nie. Serum K profiele is dus slegs van waarde om die sistemiese aktiwiteit van verskillende IKS en toedieningsstelsels te ondersoek. Slegs twee toetse, naamlik die insulien toleransie toets (ITT) en die metyrapone -(MTP)-toets (wat beide as die goue standaard van bynier funksie beskou word), kan die integriteit van die hele as meet. 2013-11-19T13:44:02Z 2014-01-21T09:25:33Z 2013-11-19T13:44:02Z 2014-01-21T09:25:33Z 2013-12 Thesis http://hdl.handle.net/10019/11052 Stellenbosch University 101 pages application/pdf application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Asthma in children Pituitary hormone releasing factors UCTD Zollner, Ekkehard Werner Arthur Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title | Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title_full | Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title_fullStr | Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title_full_unstemmed | Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title_short | Hypothalamic-pituitary-adrenal axis suppression in asthmatic children on corticosteroids |
| title_sort | hypothalamic pituitary adrenal axis suppression in asthmatic children on corticosteroids |
| topic | Asthma in children Pituitary hormone releasing factors UCTD |
| url | http://hdl.handle.net/10019/11052 |
| work_keys_str_mv | AT zollnerekkehardwernerarthur hypothalamicpituitaryadrenalaxissuppressioninasthmaticchildrenoncorticosteroids |