Adrenal suppression with glucocorticoid therapy: still a problem after all these years?

Bayman, Elizabeth; Drake, Amanda J.

doi:10.1136/archdischild-2016-311601

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…Cushing syndrome and adrenal insufficiency Many unmet needs persist around adrenal insufficiency [132,133]. Adrenal glands are called "the gland of stress".…”

Section: Ocularmentioning

confidence: 99%

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

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Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key “research statement proposals” were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn’t be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year−1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

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“…Cushing syndrome and adrenal insufficiency Many unmet needs persist around adrenal insufficiency [132,133]. Adrenal glands are called "the gland of stress".…”

Section: Ocularmentioning

confidence: 99%

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

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“…Acute AI can present with fatigue, weakness, tachycardia, hypotension, dizziness, nausea, vomiting, abdominal pain, diaphoresis and seizures. If unrecognized and not treated quickly, AI can progress to coma and death 3 6 9 22–25. Prolonged cholestatic jaundice, failure to gain weight and hypoglycemia may be the presenting clinical features in neonates and infants.…”

Section: Diagnosis Of Acute Aimentioning

confidence: 99%

“…If unrecognized and not treated quickly, AI can progress to coma and death. 3 6 9 22–25 Prolonged cholestatic jaundice, failure to gain weight and hypoglycemia may be the presenting clinical features in neonates and infants. Micropenis, bilateral cryptorchidism and, rarely, central diabetes insipidus may also be present in neonates who have AI due to panhypopituitarism.…”

Section: Diagnosis Of Acute Aimentioning

confidence: 99%

Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Miller

Spencer

Geffner

et al. 2020

Journal of Investigative Medicine

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Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient’s HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient’s home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.

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“…High-dose glucocorticoid treatment is known to cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis, and this may lead to hypoplasia and even atrophy of the adrenal cortex [1]. Thus, the body's own glucocorticoid production may be suppressed after a long-lasting or high-dose glucocorticoid treatment causing a life-threatening risk if adequate substitution is not administered.…”

Section: Introductionmentioning

confidence: 99%

Adrenal function after induction therapy for acute lymphoblastic leukemia in children short: adrenal function in ALL

2020

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Prednisolone used in the induction phase of the treatment of acute lymphoblastic leukemia (ALL) may suppress hypothalamic-pituitary-adrenal axis and require hydrocortisone substitution. In this retrospective analysis, we reviewed altogether 371 ACTH stimulation tests of 352 children after a uniform NOPHO (Nordic Society of Pediatric Hematology and Oncology) ALL induction. Both low-and standard-dose ACTH tests were used. Full recovery of adrenal function was defined by both normal basal and stimulated cortisol levels. Sixty-two percent of patients were detected with normal adrenal function in median of 15 days after tapering of prednisolone. Both low basal and stimulated cortisol levels were detected in 13% of patients. The median time to normal adrenal function was 31 days (95% CI 28-34), 24 days (95% CI 18-30), and 12 days (95% CI 10-14) for those with basal cortisol <107, 107-183, and >183 nmol/L at first ACTH testing, respectively. Patients with fluconazole prophylaxis had higher median baseline cortisol levels compared to patients without prophylaxis (207 nmol/L, range 21-839 nmol/L vs. 153 nmol/L, range 22-832 nmol/L, P = 0.003).Conclusion: These data can be used to reduce unnecessary substitution or testing, but also to guarantee hydrocortisone substitution for those at risk. What is Known:•These data can be used to reduce unnecessary hydrocortisone substitution or ACTH testing. •Our data helps to guarantee hydrocortisone substitution for those at risk of adrenal insufficiency. What is New:•Full recovery of adrenal function after ALL induction is detected in 62% of patients already at 15 days after tapering of prednisolone.•Both basal and stimulated cortisol testing are required for detection of full adrenal recovery.•Recovery time of adrenal function is extended over 3-4 weeks after tapering of prednisolone in patients with low basal cortisol levels (<107 nmol/L) at first testing.

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Adrenal suppression with glucocorticoid therapy: still a problem after all these years?

Cited by 9 publications

References 6 publications

How can we minimise the use of regular oral corticosteroids in asthma?

How can we minimise the use of regular oral corticosteroids in asthma?

Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Adrenal function after induction therapy for acute lymphoblastic leukemia in children short: adrenal function in ALL

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