ESPEYB19 15. Editors’ Choice Assorted Conditions (6 abstracts)
15.10. Metabolomic profiling reveals extensive adrenal suppression due to inhaled corticosteroid therapy in asthma
Kachroo P , Stewart ID , Kelly RS , Stav M , Mendez K , Dahlin A , Soeteman DI , Chu SH , Huang M , Cote M , Knilhtila HM , Lee-Sarwar K , McGeachie M , Wang A , Wu AC , Virkud Y , Zhang P , Wareham NJ , Karlson EW , Wheelock CE , Clish C , Weiss ST , Langenberg C & Lasky-Su JA
Nat Med. 2022;28(4):814-22. doi: 10.1038/s41591-022-01714-5.PubMed ID: 35314841
Brief summary: This study performed large-scale metabolomic profiling across 14 000 adults from 4 cohorts and identified 17 steroid metabolites whose levels were reduced in individuals with prevalent asthma. The largest reductions were associated with inhaled corticosteroid (ICS) treatment, and these were validated in samples from a clinical trial of low-dose ICS.
Even our non-endocrine colleagues and many patients are aware of the harmful effects of high dose oral corticosteroids (CS) on adrenal suppression. However, we have long considered ICS to be a relatively safe option for asthma, except at occasionally used very high doses. Here, the authors used the power of large-scale metabolomic profiling of random plasma samples to generate data on 973 metabolites. Only a minority of the metabolites tested were annotated to steroid metabolism (sub-)pathways, but most of these showed lower levels in those taking ICS. In a clinical cohort, they found that also circulating cortisol levels were lower in patients using ICS, with the largest difference seen in early morning samples. Furthermore, patients on ICS showed more symptoms of fatigue and anaemia, despite no difference in body weight.
Hence, adrenal suppression in patients with asthma treated with ICS might be more extensive than previously recognized. Widespread screening of adrenal function by dynamic testing of all children and adults taking ICS is clearly unfeasible. Instead, such patients should at least be made aware of the possible related symptoms of adrenal suppression, such as fatigue, headache, abdominal pain, vomiting and psychiatric symptoms. Furthermore, prescribing physicians and patients with asthma should be encouraged to use ICS at the lowest effective dose, to mitigate its systemic absorption and adverse effects. And, if in doubt, to test and treat patients taking ICS for subclinical adrenal insufficiency.
Article tools
My recent searches
My recently viewed abstracts
Authors
ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more