%0 Journal Article %A Ekkehard Zöllner %A Carl Lombard %A Ushma Galal %A Stephen Hough %A Elvis Irusen %A Eugene Weinberg %T Screening for hypothalamic-pituitary-adrenal axis suppression (HPAS) in asthmatic children is not possible when employing clinical and static biochemical parameters %D 2013 %J European Respiratory Journal %P P1141 %V 42 %N Suppl 57 %X Background: It is impractical to test asthmatic children for HPAS with dynamic adrenal function tests.Objective: To determine which parameter is the most useful screening test for HPAS.Methods: 143 asthmatic children were recruited. Height velocity (HV), weight velocity (WV), height standard deviation score (SDS), weight SDS, change in systolic blood pressure from supine to standing were recorded. Early morning urinary free cortisol (UFC), morning serum cortisol (C), adrenocorticotropin hormone (ACTH) and dehydroepiandrosterone sulphate (DHEAS) were collected. UFC was expressed as a ratio of Cr excretion and as a ratio of body surface area. A metyrapone (MTP) test was performed if the 08:00 hr C was >83nmol/l. Spearman correlation coefficients (r) were calculated between the post-MTP ACTH, 11-deoxycortisol (11DOC), 11DOC+C, and each variable. Diagnostic statistics were calculated.Results: All screening variables were weakly correlated with the three PMTP outcomes. Only DHEAS and UFC (nmol/m2) were statistically significant – DHEAS for PMTP ACTH and 11DOC (r = 0.20, p 0.025 & r = 0.21, p 0.017); UFC (nmol/m2) for PMTP 11DOC and 11DOC+C (r=0.19, p 0.033 & r = 0.20, p 0.022). The area under ROC curve for DHEAS in the 5-9 year age group was 0.69 (CI: 0.47-0.92). At DHEAS cut-off of 0.2 µmol/l: sensitivity = 0.88, specificity = 0.61, positive predictive value = 0.37, negative predictive value = 0.95, accuracy = 0.67, positive likelihood ratio = 2.26, negative likelihood ratio = 0.20.Conclusions: No parameter is useful as a universal screening test.DHEAS may be suitable to exclude HPAS before adrenarche. %U https://erj.ersjournals.com/content/erj/42/Suppl_57/P1141.full.pdf