OBJECTIVE: Adrenal suppression (AS), a glucocorticoid (GC) side effect with potentially significant morbidity, is poorly understood. The purpose of our study was to determine frequency, duration, and predictors of AS following a gradual taper of GC in children with rheumatic conditions. METHODS: A prospective, observational cohort study was conducted. All patients ages ≤16 years ready to discontinue GC after >4 weeks of therapy were included. Morning cortisol was tested 4 weeks after GC taper to physiologic doses and then repeatedly until normalization. GCs were subsequently discontinued and a low-dose adrenocorticotropic hormone stimulation test was performed. RESULTS: The study was completed by 31 of 39 patients. The median age was 12.9 years and median duration of GC therapy was 39.6 weeks. Seventeen patients (54.8%) had AS. Of the patients with AS, 50% showed recovery by 7 months. Two patients had persistent AS at 12 months and 1 patient at 2 years. A higher maximum GC dose was a significant predictor for the development of AS. CONCLUSION: More than 50% of our patients had AS after GC discontinuation, despite a gradual taper of GC. Stress steroids should be considered in children treated with long-term GC, even after steroid discontinuation, to prevent possible adrenal crisis.
OBJECTIVE: Adrenal suppression (AS), a glucocorticoid (GC) side effect with potentially significant morbidity, is poorly understood. The purpose of our study was to determine frequency, duration, and predictors of AS following a gradual taper of GC in children with rheumatic conditions. METHODS: A prospective, observational cohort study was conducted. All patients ages ≤16 years ready to discontinue GC after >4 weeks of therapy were included. Morning cortisol was tested 4 weeks after GC taper to physiologic doses and then repeatedly until normalization. GCs were subsequently discontinued and a low-dose adrenocorticotropic hormone stimulation test was performed. RESULTS: The study was completed by 31 of 39 patients. The median age was 12.9 years and median duration of GC therapy was 39.6 weeks. Seventeen patients (54.8%) had AS. Of the patients with AS, 50% showed recovery by 7 months. Two patients had persistent AS at 12 months and 1 patient at 2 years. A higher maximum GC dose was a significant predictor for the development of AS. CONCLUSION: More than 50% of our patients had AS after GC discontinuation, despite a gradual taper of GC. Stresssteroids should be considered in children treated with long-term GC, even after steroid discontinuation, to prevent possible adrenal crisis.
Authors: Laurie S Conklin; Jesse M Damsker; Eric P Hoffman; William J Jusko; Panteleimon D Mavroudis; Benjamin D Schwartz; Laurel J Mengle-Gaw; Edward C Smith; Jean K Mah; Michela Guglieri; Yoram Nevo; Nancy Kuntz; Craig M McDonald; Mar Tulinius; Monique M Ryan; Richard Webster; Diana Castro; Richard S Finkel; Andrea L Smith; Lauren P Morgenroth; Adrienne Arrieta; Maya Shimony; Mark Jaros; Phil Shale; John M McCall; Yetrib Hathout; Kanneboyina Nagaraju; John van den Anker; Leanne M Ward; Alexandra Ahmet; Michaelyn R Cornish; Paula R Clemens Journal: Pharmacol Res Date: 2018-09-13 Impact factor: 7.658
Authors: Alexandra Ahmet; Arati Mokashi; Ellen B Goldbloom; Celine Huot; Roman Jurencak; Preetha Krishnamoorthy; Anne Rowan-Legg; Harold Kim; Larry Pancer; Tom Kovesi Journal: BMJ Paediatr Open Date: 2019-10-23