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Iatrogenic hyperadrenocorticism during topical steroid therapy: assessment of systemic effects by metabolic criteria
VOLUME 65 NUMBER 6
tested had a positive intradermal tuberculin skin test, elevated sweat chloride concentration, or immunoglobulin deficiency. Of 23 children with PFT performed at the time of their initial evaluation, three of four group 1 patients were normal, and one had restrictive disease, and nine of 19 in group 2 had airway obstruction. During the subsequent recall period, group 1 patients had normal spirometric functions and one had a positive methacholine challenge response. Three of the 12 group 2 patients had an obstructive pattern that improved after inhaled bronchodilator and nine had normal values. When these nine children were challenged further with methacholine, eight had a positive response. After inhaled isoproterenol, all methacholine-positive patients increased their FEV, within 10 min to 85% to 116% of baseline values. Thus, of the 12 recalled group 2 patients, 11 (92%) had evidence of airway hyperreactivity; three of eight children without initial history of wheezing developed wheezing subsequently at later examinations. The authors suggest that asthma is a common cause of PRP of “unknown” etiology in children and that in some patients, PRP, rather than wheezing, may be the initial manifestation of asthma. Confirmation in older children may be accomplished by PFT (with possible methacholine challenge) to demonstrate bronchial hyperreactivity. A therapeutic trial with bronchodilators may serve to diagnose asthma in younger children. s. B.
Alphal-antitrypsin genetic phenotypes in a group of children suffering from pulmonary diseases Petrovic J, Trajkovic D, Radojcic M, Matic G, Milovanov N, Todorovic 0: Respiration 43: 127, 1982. This paper presents a study that determined a,-antitrypsin (AAT) genetic phenotypes in a group of 88 children (33 male, 55 female; ages 2 mo to 14 yr) suffering from various pulmonary diseases. Sixteen gave a history of recurrent bronchitis, 29 of bilateral pneumonia, 33 of both bronchitis and pneumonia, 5 of bronchial asthma, 3 of pneumonia and prolonged jaundice, and 2 of bronchitis and prolonged jaundice. All 88 patients underwent AAT typing, and 79 were found to have normal MM type, 4 had the MZ type, 3 had MS, 1 had MV, and 1 had FF, i.e., a prevalence rate of 10.2% for AAT variants. The nine children identified as AAT variants were found among the younger children (age range 2 mo to 6 yr) in the group. The authors conclude that despite the great amount of data concerning AAT, its precise physiological functions and the way it affects the function of certain organs is still far from being completely understood and that patients suffering from respiratory disease provide an unusual opportunity for studying the possible relationship between respiratory disease and AAT phenotype variants. A. J. C.
Abstracts
25
Pharmacology, physiology, and pathology latrogenic hyperadrenocorticism during topical steroid therapy: assessment of systemic effects by metabolic criteria Cook LJ, Freinkel RK, Zugerman Radtke R: J Am Acad Dermatol
C, Levin DL, 6:1054, 1982.
The relationship between insulin and glucose (I/G) may be employed as an aspect of risk assessment in the treatment of patients with extensive chronic skin disease (CSD) with topical glucocorticoid preparations (TGC). CSD patients tend to absorb enough TGC to suppress endogenous adrenal function. The amount absorbed may at times be large enough to induce iatrogenic Cushing’s syndrome (CS). Since it is difficult to measure blood levels of TGC, these authors investigated instead the metabolic factors influenced by glucocorticoids (GC) and chose the I/G because of the diabetogenic effect of GC. A psoriatic 36-yr-old female treated for a year with 0.25% desoximetasone cream (DMC) over 80% of the body surface developed iatrogenic CS after a short time and was an ideal subject for the study. Substitution of betamethasone valerate (BMO) for DM caused an exacerbation of exfoliative psoriasis. All the metabolic studies were performed while the patient was maintained on an 1800-calorie diet. Phase I of the study consisted of treatment with BMO, and phase 2 with DMC. Despite the finding of low levels of free circulating cortisol and 17hydroxysteroids, these steroid metabolites increased after stimulation of the patient with ACTH. The use of BMO in phase I did not disturb serum fasting glucose levels and immune insulin-like activity (IRI). In phase 2, treatment with DMC caused increases in glucose, IRI, and IRUglucase. Oral glucose tolerance was abnormal during both phases, but peak plasma glucose was highest during use of DMC. Insulin resistance was inferred because plasma glucose failed to decline less than 50% during insulin tolerance tests performed in both phases of the study. Peripheral WBC counts paralleled changes in carbohydrate metabolism. The authors believe that since there are measurable parameters of impending hyperadrenocorticism, it is no longer necessary to rely on the physical appearance of the patient as an indicator of excessive TGC absorption. D.
Smoking bronchial
and circulating carcinoma
HBllgren R, N&I E, Arrendal Med Sand 211:269, 1982.
1. S.
IgE in H, Hiesche
K: Acta
These authors surveyed a group of patients with bronchogenic carcinoma (BC) and found that male smoking members of the group tended to have higher serum levels of IgE (sIgE) than did the nonsmoking members. The work of other investigators has shown that serum IgG and IgA levels
tested had a positive intradermal tuberculin skin test, elevated sweat chloride concentration, or immunoglobulin deficiency. Of 23 children with PFT performed at the time of their initial evaluation, three of four group 1 patients were normal, and one had restrictive disease, and nine of 19 in group 2 had airway obstruction. During the subsequent recall period, group 1 patients had normal spirometric functions and one had a positive methacholine challenge response. Three of the 12 group 2 patients had an obstructive pattern that improved after inhaled bronchodilator and nine had normal values. When these nine children were challenged further with methacholine, eight had a positive response. After inhaled isoproterenol, all methacholine-positive patients increased their FEV, within 10 min to 85% to 116% of baseline values. Thus, of the 12 recalled group 2 patients, 11 (92%) had evidence of airway hyperreactivity; three of eight children without initial history of wheezing developed wheezing subsequently at later examinations. The authors suggest that asthma is a common cause of PRP of “unknown” etiology in children and that in some patients, PRP, rather than wheezing, may be the initial manifestation of asthma. Confirmation in older children may be accomplished by PFT (with possible methacholine challenge) to demonstrate bronchial hyperreactivity. A therapeutic trial with bronchodilators may serve to diagnose asthma in younger children. s. B.
Alphal-antitrypsin genetic phenotypes in a group of children suffering from pulmonary diseases Petrovic J, Trajkovic D, Radojcic M, Matic G, Milovanov N, Todorovic 0: Respiration 43: 127, 1982. This paper presents a study that determined a,-antitrypsin (AAT) genetic phenotypes in a group of 88 children (33 male, 55 female; ages 2 mo to 14 yr) suffering from various pulmonary diseases. Sixteen gave a history of recurrent bronchitis, 29 of bilateral pneumonia, 33 of both bronchitis and pneumonia, 5 of bronchial asthma, 3 of pneumonia and prolonged jaundice, and 2 of bronchitis and prolonged jaundice. All 88 patients underwent AAT typing, and 79 were found to have normal MM type, 4 had the MZ type, 3 had MS, 1 had MV, and 1 had FF, i.e., a prevalence rate of 10.2% for AAT variants. The nine children identified as AAT variants were found among the younger children (age range 2 mo to 6 yr) in the group. The authors conclude that despite the great amount of data concerning AAT, its precise physiological functions and the way it affects the function of certain organs is still far from being completely understood and that patients suffering from respiratory disease provide an unusual opportunity for studying the possible relationship between respiratory disease and AAT phenotype variants. A. J. C.
Abstracts
25
Pharmacology, physiology, and pathology latrogenic hyperadrenocorticism during topical steroid therapy: assessment of systemic effects by metabolic criteria Cook LJ, Freinkel RK, Zugerman Radtke R: J Am Acad Dermatol
C, Levin DL, 6:1054, 1982.
The relationship between insulin and glucose (I/G) may be employed as an aspect of risk assessment in the treatment of patients with extensive chronic skin disease (CSD) with topical glucocorticoid preparations (TGC). CSD patients tend to absorb enough TGC to suppress endogenous adrenal function. The amount absorbed may at times be large enough to induce iatrogenic Cushing’s syndrome (CS). Since it is difficult to measure blood levels of TGC, these authors investigated instead the metabolic factors influenced by glucocorticoids (GC) and chose the I/G because of the diabetogenic effect of GC. A psoriatic 36-yr-old female treated for a year with 0.25% desoximetasone cream (DMC) over 80% of the body surface developed iatrogenic CS after a short time and was an ideal subject for the study. Substitution of betamethasone valerate (BMO) for DM caused an exacerbation of exfoliative psoriasis. All the metabolic studies were performed while the patient was maintained on an 1800-calorie diet. Phase I of the study consisted of treatment with BMO, and phase 2 with DMC. Despite the finding of low levels of free circulating cortisol and 17hydroxysteroids, these steroid metabolites increased after stimulation of the patient with ACTH. The use of BMO in phase I did not disturb serum fasting glucose levels and immune insulin-like activity (IRI). In phase 2, treatment with DMC caused increases in glucose, IRI, and IRUglucase. Oral glucose tolerance was abnormal during both phases, but peak plasma glucose was highest during use of DMC. Insulin resistance was inferred because plasma glucose failed to decline less than 50% during insulin tolerance tests performed in both phases of the study. Peripheral WBC counts paralleled changes in carbohydrate metabolism. The authors believe that since there are measurable parameters of impending hyperadrenocorticism, it is no longer necessary to rely on the physical appearance of the patient as an indicator of excessive TGC absorption. D.
Smoking bronchial
and circulating carcinoma
HBllgren R, N&I E, Arrendal Med Sand 211:269, 1982.
1. S.
IgE in H, Hiesche
K: Acta
These authors surveyed a group of patients with bronchogenic carcinoma (BC) and found that male smoking members of the group tended to have higher serum levels of IgE (sIgE) than did the nonsmoking members. The work of other investigators has shown that serum IgG and IgA levels