Serum dehydroepiandrosterone sulfate concentration as an indicator of adrenocortical suppression in asthmatic children treated with inhaled steroids

ACTH regulates adrenal androgen production, which may thus be reduced durin g glucocorticosteroid therapy. Dehydroepiandrosterone sulfate is the most a bundant androgen secreted by the adrenals. We wished to evaluate whether se rum levels of dehydroepiandrosterone sulfate can be used as an indicator of adrenal suppression during inhaled steroid treatment in children. Sixty sc hool-aged children with newly diagnosed asthma were randomly divided into b udesonide (n = 30) and fluticasone propionate (n = 30) groups. Fifteen crom one-treated children served as a control group. The budesonide dose was 800 mug/d during the first 2 months and 400 mug/d thereafter. The respective f luticasone propionate doses were 500 and 200 mug/d. Serum dehydroepiandrost erone sulfate concentrations were measured before and after 2 and 4 months of treatment. In the budesonide group, serum dehydroepiandrosterone sulfate decreased fro m the baseline by a mean of 21% (95% confidence interval, 13-29%; P < 0.001 ) after 2 months of high dose treatment and by 16% (95% confidence interval , 8-25%; P < 0.001) after 4 months of treatment. In the fluticasone propion ate group, the respective figures were 10% (95% confidence interval, 4-16%; P < 0.01) and 6% (95% confidence interval, 16% decrease-3% increase; P = N S). A low dose ACTH test indicated adrenocortical suppression at 4 months i n 14 (23%) steroid-treated children. In these children, dehydroepiandroster one sulfate decreased by a mean of 21% (95% confidence interval, 14-28%), w hereas in those 46 steroid-treated children with normal ACTH test results, dehydroepiandrosterone sulfate decreased by 8% (95% confidence interval, 0- 16%; P < 0.05 between these groups). In the control group, dehydroepiandros terone sulfate levels tended to increase (by a mean of 26%), reflecting the normal physiological change at this age. In conclusion, inhaled steroid treatment suppresses dehydroepiandrosterone sulfate production in a dose-dependent manner. Monitoring of serum dehydroe piandrosterone sulfate concentrations can be used as a practical method to follow adrenocortical function and to detect its suppression during inhaled steroid treatment in children.