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Endogenous Glucocorticoid Response to Single-Dose Dexamethasone for Croup in Children: A Pharmacodynamic Study
Pediatric Emergency Care
  • Natasha Gill
  • Natalie Sirizzotti
  • David Johnson
  • Gary Joubert, Western University
  • Andrew S Kucey
  • Alvin Tieu
  • Brad L Urquhart
  • Melanie Columbus
  • Rodrick Lim, Western University
  • Michael Rieder, University of Western Ontario
  • Shruti Mehrotra, Western University
  • Emily D Hartjes
  • Naveen Poonai, Western University
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OBJECTIVES: Dexamethasone is associated with adrenal insufficiency in adults and children with chronic disease. This association has not been studied after single-dose oral dexamethasone, the standard of care for children with croup. We hypothesized that single-dose oral dexamethasone in children with croup is associated with a transient decrease in endogenous glucocorticoids.

METHODS: We conducted a prospective, 2-arm, pharmacodynamic study of single-dose oral dexamethasone 0.6 mg/kg (maximum, 12 mg) in children older than 2 years with croup compared with controls (children with febrile upper respiratory tract infections who did not receive dexamethasone). Primary outcome was urinary 6β-hydroxycortisol-cortisol ratio.

RESULTS: Twenty-seven children were analyzed (22 with croup and 5 with upper respiratory tract infections). Median 6β-hydroxycortisol-cortisol ratios before dexamethasone, the following morning, and on days 1, 3, and 7 were 2.8, 2.2, 2.0, 2.8, and 2.6, respectively. Among controls, the median 6β-hydroxycortisol-cortisol ratios at the same time intervals was 1.9, 1.5, 1.8, 2.5, and 1.7, respectively. There were no significant differences in the change from time 0 between groups at any time point. There were no serious adverse events or infectious complications.

CONCLUSIONS: Single-dose oral dexamethasone is not associated with decreased endogenous corticosteroid levels in children with croup. Future studies should use criterion standard tests to rule out suppression of the hypothalamic-pituitary-adrenal axis and be powered sufficiently to identify adverse clinical outcomes.

Citation Information
Natasha Gill, Natalie Sirizzotti, David Johnson, Gary Joubert, et al.. "Endogenous Glucocorticoid Response to Single-Dose Dexamethasone for Croup in Children: A Pharmacodynamic Study" Pediatric Emergency Care Vol. 36 Iss. 1 (2020) p. 50 - 56
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