Endocrine Abstracts

Introduction: Steroid treatment is beneficial and important for many conditions in paediatrics. However, paediatricians are forced to balance the benefits with a number of side effects, including dysglycaemia, weight gain and adrenal suppression. Early diagnosis and treatment of adrenal suppression is important for morbidity and mortality due to the risk of an adrenal crisis, most commonly after gastrointestinal infections.

Aims: Our primary aim was to identify the incidence of patients with steroid-induced adrenal suppression at our local DGH, from endocrinologist referrals, due to concern of prolonged or high-dose steroid use. We hoped to describe the characteristics of patients with adrenal suppression and establish a management Pathway.

Results: We had a total of 39 patients referred due to prolonged or high-dose steroid use. 13 (33%) were female and the most common primary diagnosis was respiratory (30). 3 (7.7%) of our patients were suppressed, with asthma, IBD and nephrotic syndrome. Two patients had been managed on long-term oral steroids (prednisolone/budesonide), whilst one required multiple oral courses, in addition to high-dose inhaled steroids (Seretide 1000 mg/day). All 3 children were started on hydrocortisone and given sick day rules as per BSPED guidelines.

Discussion: Whilst we know the risk of adrenal suppression in adults on steroids, there is little data in children and no clear evidence on cumulative steroid dose thresholds for development of adrenal suppression. Our suppressed patients had all been treated with oral steroids over the previous year, with one using high-dose inhaled steroids. The steroid doses were above the screening threshold of our tertiary guideline. Most children on inhaled steroids were not suppressed, despite being above the guideline threshold. Studies have shown that inhaled corticosteroids have the potential to cause adrenal suppression in paediatrics, although our results show this to be at a high level, combined with additional oral steroids. Further research on thresholds will help guide clinicians on when to screen for adrenal suppression, together with research on the reliability of salivary cortisol measurements, to prevent noxious tests in our paediatric cohort. In the meantime, it is pertinent to continue to educate families and clinicians on adrenal crisis to safeguard our patients.