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Corticosteroid hormones in children with allergic disorders. I. New rapid ACTH test and circadian secretion of ACTH and cortisol in allergic patients



Corticosteroid hormones in children with allergic disorders. I. New rapid ACTH test and circadian secretion of ACTH and cortisol in allergic patients



Arerugi 37(9): 926-934



To test the integrity of the hypothalamic-pituitary-adrenal axis in allergic children, we measured serum cortisol, 11-OHCS in response to modified rapid ACTH test and daily variation in concentration of plasma cortisol and ACTH. The modified rapid ACTH test was performed on 74 allergic patients (8 mila, 18 moderate and 29 severe asthmatic patients and 19 atopic dermatitis patients), and we found two kinds of criterion for the diagnosis. One was a pre-value in serum cortisol and 11-OHCS levels. 10 .mu.g/dl for the cortisol level and 8 .mu.g/dl for the 11-OHCS level would be criterial levels. The other was the difference in serum cortisol and 11-OHCS levels between 2 hours' and 3 hours' value. When severity in allergic condition and necessity for steroid increased, the level at 3 hours decreased in comparison with 2 hours. This method is considered to be very useful for the screening procedure for the hypothalamic-pituitary-adrenal axis, since it reflects the severity of illness and the frequency of steroid administration in a patient and since it seems to be safe because we can observe the patient during the drip. The daily variation in concentration of plasma cortisol and ACTH was observed in 20 patients. As a result, we classified five types of secretory pattern in ACTH circadian rhythm (type 1 = very low secretory type, type 2 = low secretory type, type 3 = high secretory type, type 4 = arrhythmic secretory type, type 5 = normal secretory type). If we show their rank order in the damage in hypothalamic-pituitary-adrenal function, it would be as follows; type 1 > type 2 > type 4 > type 3 .gtoreq. type 5. We think these two kinds of examinations, modified rapid ACTH and the daily variation in concentration of plasma cortisol and ACTH, are very useful in testing the function of hypothalamic-pituitary adrenal axis.

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Accession: 007165107

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PMID: 2854722


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