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Clinical Trial
. 2016 Jan;39(1):93-6.
doi: 10.1007/s40618-015-0323-6. Epub 2015 Jun 10.

Reproducibility and utility of an overnight 0.25 mg dexamethasone suppression test as a marker for glucocorticoid sensitivity in children with asthma

R H Willemsen  1   2 , L van Leeuwen  3 , T A S Voorend-van Bergen  4 , Y B de Rijke  5 , M W Pijnenburg  4 , E L T van den Akker  3
Affiliations
Clinical Trial

Reproducibility and utility of an overnight 0.25 mg dexamethasone suppression test as a marker for glucocorticoid sensitivity in children with asthma

R H Willemsen et al. J Endocrinol Invest. 2016 Jan.

Abstract

Purpose: Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment in children. However, there is considerable inter-individual variation in glucocorticoid sensitivity, leading to over- as well as undertreatment. A simple and fast test to predict glucocorticoid sensitivity would enable more tailored therapy in children with asthma.

Aim: To study reproducibility and utility of an overnight 0.25 mg dexamethasone suppression test (DST) with salivary cortisol levels as marker for glucocorticoid sensitivity in asthmatic children.

Methods: 23 children with atopic asthma were recruited for two overnight 0.25 mg DST's, 1 month apart.

Results: Baseline cortisol levels correlated well between both tests. However, cortisol levels, change in cortisol levels or fractional suppression of cortisol levels after dexamethasone did not correlate between the two tests. Bland-Altman plots showed that the difference in salivary cortisol levels between test 1 and 2 of an individual patient could go up to 12 nmol/l, which is a clinically relevant difference. ICS dose did not correlate with baseline cortisol levels, height and BMI SDS.

Conclusion: The low-dose salivary DST test in its current form is not suitable for use in clinical practice in children with asthma, due to low reproducibility. Therefore, studies using the 0.25 mg salivary DST should be interpreted cautiously.

Keywords: Asthma; Glucocorticoid sensitivity; Paediatric endocrinology.

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Figures

Fig. 1
Fig. 1
a Bland–Altman plot for salivary cortisol levels before dexamethasone test 1 vs. test 2. The line ‘mean’ indicates the mean difference between test 1 and 2 for all participants. Also, the 95 % CI for the difference between test 1 and 2 is indicated, showing that there is considerable variation between test 1 and 2, and thus poor reproducibility. b Bland–Altman plot for salivary cortisol levels after dexamethasone test 1 vs. test 2
See this image and copyright information in PMC

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