NeSST2: The Development of a Noninvasive Short Synacthen Test
Status:
Suspended
Trial end date:
2020-12-01
Target enrollment:
Participant gender:
Summary
Recently there has been concern about the effect of inhaled steroids, routinely used in the
treatment of asthma, on the body's ability to produce its natural stress hormone cortisol.
Failure of adequate cortisol production in times of stress e.g. illness, can result in
serious illness or death. Patients receiving longterm steroid treatment may have reduced
levels of cortisol and not be able to produce adequate amounts in times of need, a process
called adrenal suppression. Initially it was thought that the absorption of inhaled steroids
into the bloodstream would be too low to cause adrenal suppression however high profile
deaths followed by a national survey revealed a number of fatal or near fatal cases of
adrenal suppression. The vast majority of these were in children. Since then doctors have
been encouraged to ensure that children on high doses of inhaled steroids carry a steroid
alert card and that the ability of their adrenal glands to produce adequate amounts of
cortisol is checked. However it is unknown what dose of inhaled steroids puts one at risk,
whether age or gender affects one's risk and when to check the function of the adrenal gland.
The Short Synacthen Test (SST) investigates the ability of the body's adrenal glands to
produce cortisol. Presently the SST requires intravenous (i.v) cannulation through which
Synacthen is injected to stimulate the adrenal glands and multiple blood samples are
collected to assess the response in terms of cortisol production. It is invasive, time
consuming and unpleasant for the child. Our project aims to produce a noninvasive alternative
to the current SST, with Synacthen given nasally and using saliva to measure the subsequent
production of cortisol. A noninvasive test will allow us to establish the first normal ranges
for children and determine which children with asthma are at risk of adrenal suppression.