Basal serum dehydroepiandrosterone sulphate concentration does not predict the cortisol response to provocative testing

Asthma and dehydroepiandrosterone (DHEA): facts and hypotheses

Dehydroepiandrosterone (DHEA) is considered as an important immunomodulating and anti-inflammatory hormone. Despite the continuing interest in DHEA replacement therapy, our knowledge of its effects upon asthma is very limited. DHEA is able to reverse cytokine imbalances associated with asthma, may prevent and attenuate allergic inflammation in airways, and does not possess the undesirable side effects of glucocorticoids; therefore, it may be potentially applied in the treatment of asthma. The steroid-sparing effect observed with DHEA clinically could appear especially favorable in asthmatic patients receiving oral treatment and those inhaling high doses of glucocorticoids. In addition, DHEA and its analogs might prove useful in reversing relative glucocorticoids insensitivity in patients with corticosteroid-resistant asthma. In this review we have focused specifically on DHEA's role in asthma.

Inhaled glucocorticoids and adrenal function: an update

For the vast majority of asthmatic children, treatment with inhaled glucocorticoids is safe and effective. Mild impairment of adrenal function of doubtful clinical significance is known to occur in some children inhaling > or = 400 micro g/day budesonide and beclomethasone or > or = 200 micro g fluticasone. Recent reports of life-threatening adrenal failure in asthmatic children inhaling glucocorticoids, some of whom were prescribed licensed doses, have prompted the recommendation that the use of high-dose inhaled glucocorticoids, particularly fluticasone, should be avoided. However, the importance of correctly diagnosing asthma, of using the minimum dose of inhaled glucocorticoid required for symptom control and of regular growth-velocity assessment cannot be over-emphasised. Appropriate asthma management including the early introduction of steroid-sparing agents such as a long-acting beta-agonist or leukotriene antagonist may reduce the morbidity associated with inhaled glucocorticoid use but some children, for reasons as yet unknown, may exhibit increased sensitivity to the systemic effects of inhaled glucocorticoid treatment. Possible explanations for this, with reference to the pharmacology and molecular mechanisms of glucocorticoid action, are accompanied in this review by a summary of the recent case reports and discussion of assessment of adrenal function.

Steroid assays in saliva: a method to detect plasmatic contaminations

Plasmatic and salivary levels of six steroid hormones in adult males and females are given and compared to the data of the literature. These steroids are: cortisol (F), dehydroepiandrosterone (DHA) and its sulphate (DHAS), androstenedione (A), testosterone (T) and 11 beta OH androstenedione (OHA). The salivary assay of the last compound is an original. The correlations between salivary and plasmatic values are presented and confirm that this method is a reliable alternative for hormonal investigations. From these data and from those of the literature, the salivary versus plasmatic ratio are calculated. From the fact that high concentrations of DHAS in saliva generally stem from blood contamination, we derive a method to estimate the amount of this contamination and its impact on other steroids measured on the same saliva sample.