Endocrine Abstracts

Background: Prolonged and high dose glucocorticoids can result in steroid induced adrenal insufficiency (SIAI). While guidance exists regarding who is at risk of SIAI, the evidence based remains limited. Similarly, evidence-based guidance for weaning children off steroids safely but in a timely manner are lacking.

Aims: Identify factors influencing SIAI and recovery in children treated with prolonged glucocorticoids.

Methods: A retrospective cohort study of paediatric patients who underwent their first Short Synacthen Test (SST) for suspected SIAI between 2018 and 2023 at three tertiary UK centres (Sheffield, Nottingham, London). Patient demographics, steroid formulation, dose and SST results were collected. Patients were categorised as ‘sufficient’, ‘insufficient’ or ‘borderline’ based on their first SST outcome.’ A physiological hydrocortisone-equivalent dose was defined as 10 mg/m²/day. SPSS and ANCOVA were used for multiple and logistical regressions.

Results: Among 146 patients who underwent 200 tests, 102 (51%) were ‘sufficient’, 75 ‘insufficient’ and 23 ‘borderline’. The average wean to a physiological steroid dose was 78 and 112 days for the sufficient and insufficient groups respectively. Patients had a higher median peak cortisol on SST when weaned on prednisolone compared to hydrocortisone (461.1 vs 373.4 nmol/l, P = 0.0012). The management of steroid doses following a failed SST (whether a dose was continued or changed) did not significantly affect likelihood of success of the following SST (P = 0.324). Independent variables including age, sex, steroid formulation, treatment duration, total steroid duration, days since physiological dose reached, average dose 14 days prior to SST, IV methylprednisolone had no statistically significant effect on the likelihood of passing SST or on cortisol measurements. However, the sufficient group had a significantly higher mean age at steroid initiation and lower mean daily HC dose compared to the insufficient group (P = 0.003).

Discussion: An adequate response to the first SST is statistically significantly associated with a shorter steroid wean, weaning on prednisolone rather than hydrocortisone, and lower steroid dose at SST. Younger age and higher steroid dose are risk factors for SIAI. Further research is needed to clarify others factors influencing SIAI and to guide paediatric steroid weaning strategies.