Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseases.
OBJECTIVE
Glucocorticoids (GCs) are often used for the treatment of rheumatic disorders. However, doses are prescribed, which may suppress the hypothalamic-pituitary-adrenal (HPA) axis. After GC withdrawal, recovery of the HPA axis may be delayed putting the patient at risk for adrenal insufficiency. We assessed adrenal function and factors influencing adrenal responsiveness after termination of GC therapy in paediatric patients with rheumatic diseases.


METHODS
Nineteen patients aged 2-15 years were followed clinically, and adrenal function was tested by low-dose adrenocorticotropic hormone test 1 month after GC withdrawal. In case of adrenal insufficiency by test, re-assessment was performed after 6 and 18 months.


RESULTS
No signs or symptoms of adrenal insufficiency occurred in any of the patients during and after GC withdrawal. Biochemical examination revealed adrenal insufficiency in 32% (6/19) at 4 weeks and in 11% (2/19) at 20 months after GC withdrawal.


CONCLUSIONS
In conclusion, current strategies to withdraw GC from paediatric patients with rheumatic diseases are safe. Routine adrenal function testing after GC therapy and withdrawal may not be needed considering the low risk but high number of patients treated with GCs. Nevertheless, awareness of the potential risk and information of patients and their caregivers are crucial to avoid adrenal crisis.
Huber
Benedikt M
BM
Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland.
Bolt
Isabel B
IB
Sauvain
Marie-Josèphe
MJ
Flück
Christa E
CE
D000293:Adolescent; D000311:Adrenal Glands / Q000187:drug effects* / Q000503:physiopathology; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D008297:Male; D010913:Pituitary-Adrenal System / Q000187:drug effects; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012306:Risk; D016896:Treatment Outcome
D005938:Glucocorticoids