ABSTRACT
INTRODUCTION: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. METHOD: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). RESULTS: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). CONCLUSION: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Adrenal Insufficiency/chemically induced , Asthma/drug therapy , Hypothalamo-Hypophyseal System/drug effects , Pituitary-Adrenal System/drug effects , Administration, Inhalation , Administration, Oral , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/physiopathology , Asthma/physiopathology , Child , Child, Preschool , Disease Progression , Female , Humans , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/physiopathology , Infant , Luminescent Measurements , Male , Pituitary-Adrenal System/physiopathology , Prospective Studies , Reference Values , Risk Factors , Statistics, Nonparametric , Time FactorsABSTRACT
The use of three different gonadotropins was tested for estrous induction in dairy goats during the non-breeding season. All does received an injection of 30 µg of d-cloprostenol and intravaginal sponges containing 60mg of medroxyprogesterone acetate (MAP) for 6 d plus 20 IU of porcine FSH (pFSH), 200 IU of eCG or 250 IU of hCG 24h before sponge removal. In Experiment 1 (n=24), ovarian ultrasound parameters were recorded and cervical mucus was evaluated daily for 5 d after sponge removal or until ovulation. In Experiment 2 (n=80), reproductive efficiency of artificially inseminated or naturally mated does was assessed. The mean interval from sponge removal to ovulation (73.5±23.7 h), number of ovulations (1.6±0.7) and ovulatory follicle diameter (7.2±0.8 mm) did not vary (P >0.05) among the three groups. At ovulation, cervical mucus had crystalline-striated to striated (22.2%), striated to striated-caseous (72.2%) and striated-caseous to caseous (5.6%) appearance. The largest follicle diameter was greater (P <0.05) in does with crystalline (6.7±1.4 mm), crystalline-striated (7.2±1.1 mm) or striated (7.3±1.3 mm) mucus than in those with striated-caseous (5.3±1.4 mm) or caseous (4.5±1.1 mm) mucus. Percentage of animals exhibiting estrus (92.5%) and conception rate (60.8%) were similar (P >0.05) among the three gonadotropins groups. Results of this study support the use of eCG (200 IU), hCG (250 IU) and pFSH (20 IU) for the estrous induction protocols in dairy goats during the non-breeding season. Cervical mucus evaluation can be used as an additional method to determine the optimal time for artificial insemination in goats.
Subject(s)
Cervix Mucus/drug effects , Cloprostenol/administration & dosage , Estrus Synchronization/methods , Medroxyprogesterone Acetate/administration & dosage , Progestins/administration & dosage , Reproduction/physiology , Animals , Cervix Mucus/diagnostic imaging , Female , Goats , Insemination, Artificial/veterinary , Reproduction/drug effects , UltrasonographyABSTRACT
Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.
Resumo Introdução: A corticoterapia oral (CO) é um dos pilares do tratamento na exacerbação da asma, e cursos de curta duração são geralmente considerados seguros. No entanto, crianças submetidas a repetidos cursos estão sujeitas a disfunção do eixo hipotálamo-hipófise-adrenal (HHA). Objetivo: Investigar a integridade do eixo HHA em crianças com asma persistente ou sibilância recorrente com indicação para corticoterapia inalatória (CI). Método: Avaliação do cortisol sérico basal antes da introdução da CI e 30, 60 e 90 dias após iniciado o tratamento, utilizando-se o imunoensaio ImmuliteÒ Siemens Medical Solutions Diagnostic chemiluminescent (Los Angeles, EUA; 2006). Resultados: Das 140 crianças avaliadas (0,3 a 15 anos de idade) com asma persistente ou sibilância recorrente, 40% relataram ter recebido CO no último mês antes da avaliação. Cerca de 12,5% delas apresentaram supressão adrenal bioquímica e evoluíram com recuperação do eixo HHA durante os primeiros três meses em CI. O número de dias livres de CO e a duração do último curso antes da avaliação do cortisol não foram significativamente diferentes entre as crianças com ou sem supressão adrenal (p=0,29 e p=0,20, respectivamente). O número de cursos de curta duração relatados no ano anterior à avaliação também não esteve associado à supressão adrenal (p=0,89). Conclusão: A utilização dos corticosteroides nas doses convencionais, em cursos de curta duração, pode colocar as crianças em risco de disfunção do eixo HHA. A recuperação desse eixo é possível durante a CI. Profissionais de saúde devem estar atentos para a possibilidade de resposta inadequada ao estresse durante o acompanhamento de crianças com asma persistente ou sibilância recorrente.
