Assessment of adrenal function after oral prednisolone therapy in children with epileptic spasms

Ram Tapela; Preeti Singh; Anju Seth; Suvasini Sharma

doi:10.1530/endoabs.110.P37

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Endocrine Abstracts (2025) 110 P37 | DOI: 10.1530/endoabs.110.P37

ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)

Assessment of adrenal function after oral prednisolone therapy in children with epileptic spasms

Ram Tapela ¹ , Preeti Singh ² , Anju Seth ² & Suvasini Sharma ²

Author affiliations

¹Lady Hardinge Medical College, Lady Harding Medical College, Pediatrics, New Delhi, India; ²Lady Hardinge Medical College, Lady Harding Medical College, Pediatrics, New Delhi, India

JOINT2736

Background: Epileptic spasms, including West syndrome, are severe pediatric neurological disorders associated with developmental delays and neurocognitive impairment. High-dose oral prednisolone is a first-line treatment but carries a risk of adrenal insufficiency (AI). Evaluating adrenal function post-treatment is crucial, particularly in resource-limited settings where routine testing may not be feasible.

Objectives: This study aimed to determine the proportion of children with AI at 5 days and 6–8 weeks after stopping prednisolone. Additionally, it assessed adrenal recovery at 6–8 weeks in those diagnosed with AI at 5 days, examined treatment-related adverse effects, and identified potential AI risk factors.

Methods: A prospective analytical study was conducted on 40 children (6–19 months, mean age: 10.10±3.69 months) who completed high-dose oral prednisolone therapy (4 mg/kg/day for 2 weeks, followed by a 4-week taper). Adrenal function was evaluated using basal cortisol and ACTH stimulation tests at 5 days and 6–8 weeks post-treatment completion. Adrenal recovery was defined as a stimulated cortisol level ≧18 μg/dL.

Results: At 5 days post-therapy, all children exhibited AI as confirmed by ACTH stimulation testing, with 97.5% having inconclusive basal cortisol levels (3–18 μg/dL). By 6–8 weeks, 72.5% showed adrenal recovery. One child experienced an adrenal crisis at 2 weeks but recovered by the second assessment. Cushingoid facies was observed in 85% at 5 days, decreasing to 72.5% by 6–8 weeks. Elevated blood pressure was noted in 70%, reducing to 55%, with 5% developing persistent hypertension. No cases of hyperglycemia, cataracts, or glaucoma were detected. All children exhibited global developmental delay, which was unrelated to adrenal function. AI was not significantly associated with age, gender, socioeconomic status, stunting, hypertension, or cumulative prednisolone dose.

Table 1 Baseline and ACTH stimulated serum cortisol levels at the first and second assessments.
	Mean (S.D.)
	First assessment (5 days post-therapy)	Second assessment (6–8 weeks post-therapy)	Mean difference [95% CI]	P-value
Basal serum cortisol (ug/dl)	7.15(2.34)	14.72(2.26)	7.58[6.86 to 8.29	<0.001*
ACTH stimulated serum cortisol at 1 hr. (ug/dl)	9.08(2.58)	18.03(2.24)	8.95[8.28 to 9.61]	<0.001*
P value <0.05 – significant

Conclusions: AI is universal following high-dose prednisolone therapy in children with epileptic spasms but shows significant recovery within 6–8 weeks. Routine adrenal function testing is essential to identify at-risk children, minimizing the risk of adrenal crisis and guiding the rational use of stress-dose steroids.

Keywords: Adrenal insufficiency, ACTH stimulation test, Cortisol.