ANALYSIS OF CORTISOL LEVEL AFTER HIGH-DOSE AND LONG-TERM PREDNISONE EXPOSURE IN CHILDREN WITH STEROID-SENSITIVE NEPHROTIC SYNDROME


Nani Wijayanti Dn, Nun Zairina, Ninik Asmaningsih, Yulistiani Yulistiani

Abstract


Objective: The objective of this study is to analyze the cortisol levels in induction and alternate phases associated with the clinical manifestation in the developing of adrenal suppression.

Methods: An observational, longitudinal study which had been approved by the ethical committee of Dr. Soetomo Teaching Hospital Surabaya was conducted from June to October 2016. The cortisol levels were measured before induction phase (t=0), after induction phase (t=1), and after alternate phase (t=2). The venous blood samples were obtained in the morning at 08.00–09.00 am. The data were analyzed using student’s t-test.

Results: A total of 15 patients were included, but 6 patients were excluded because of cross-reactivity with prednisone when using ADVIA Centaur Cortisol Assay. 9 patients (55.56% boys) had a mean age 6–< 12 years old and 33.33% were initial attack and dependent steroid nephrotic syndrome. 8 of 9 patients had a normal cortisol level at baseline (t=0). The cortisol level decrement in the induction phase was 72.92% (11.79±10.66 mcg/dL–1.75±1.08 mcg/dL) (*p=0.024). After alternate phase, the cortisol levels increased 417.60% (1.75±1.08 mcg/dL to 5.95±3.33 mcg/dL (*p=0.007). The clinical manifestation as nausea/vomiting and abdominal distension only appeared in 11.11% of patients in the induction phase but not in the alternate phase.

Conclusions: Hypothalamus-pituitary-adrenal (HPA) axis suppression could develop after induction phase which was indicated by low cortisol levels. High-dose and long-term prednisone exposure decreased the cortisol levels reversibly. The clinical manifestation of adrenal suppression as weakness, nausea/vomiting, acute dehydration, and abdominal distension almost did not manifest in all patients.


Keywords


Cortisol, Nephrotic syndrome, Sensitive steroid nephrotic syndrome, Prednisone, High-dose prednisone, Long-term prednisone, Hypothalamus-pituitary-adrenal axis suppression, Children.

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About this article

Title

ANALYSIS OF CORTISOL LEVEL AFTER HIGH-DOSE AND LONG-TERM PREDNISONE EXPOSURE IN CHILDREN WITH STEROID-SENSITIVE NEPHROTIC SYNDROME

Keywords

Cortisol, Nephrotic syndrome, Sensitive steroid nephrotic syndrome, Prednisone, High-dose prednisone, Long-term prednisone, Hypothalamus-pituitary-adrenal axis suppression, Children.

DOI

10.22159/ajpcr.2018.v11s3.30031

Date

06-10-2018

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 11 Special issue 3 2018 Page: 56-60

Print ISSN

0974-2441

Online ISSN

2455-3891

Authors & Affiliations

Nani Wijayanti Dn
Department of Pharmacy, Hang Tuah University, Surabaya, Java, Indonesia.
Indonesia

Nun Zairina
Department of Pharmacy, Installation of Dr. Soetomo Teaching Hospital Surabaya, Surabaya, Java, Indonesia.
Indonesia

Ninik Asmaningsih
Department of Pediatrics, Nephrology Division, Dr. Soetomo Teaching Hospital Surabaya, Surabaya, Java, Indonesia.
Indonesia

Yulistiani Yulistiani
Department of Pharmacy, Hang Tuah University, Surabaya, Java, Indonesia.
Indonesia


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