title: Adrenal insufficiency during physiological stress in children after kidney or liver transplantation.
abstract: The aim of this study was to assess the prevalence and risk factors of AI in pediatric recipients of kidney or liver transplantation admitted because of a physiological stress episode and to identify patients that might be at risk of adrenal crises by clinical and laboratory parameters at admission. Adrenal function was prospectively evaluated by a standard (250 μg) adrenocorticotropin test in 48 recipients. Data on clinical and laboratory parameters were collected. AI was diagnosed in 11 patients: 10/32 (31.3%) children on long-term steroid treatment and 1/16 (6.25%) untreated. The only risk factor for AI was corticosteroids cumulative dose of >0.15 mg/kg/day during the last six months (p = 0.02, OR 6.67; 95% CI: 0.97-45.79). No correlation was found between clinical or laboratory signs of adrenal crisis on admission and the presence of AI. None of the patients with AI who did not receive stress dose (n = 8) developed adrenal crisis. AI is relatively common in children receiving prolonged corticosteroid treatment after kidney or liver transplantation. Clinical parameters on admission could not reliably identify patients with AI. Universal administration of a stress dose during physiological stress might not be required. However, at this point, the only method to identify patients that will benefit from a stress dose is through the ACTH test.
authors: Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
authors: Efraim
authors: E
authors: Bilavsky
authors: Adi
authors: A
authors: Dagan
authors: Havatzelet
authors: H
authors: Yarden-Bilavsky
authors: Miriam
authors: M
authors: Davidovits
authors: Rivka
authors: R
authors: Shapiro
authors: Eytan
authors: E
authors: Mor
authors: Naomi
authors: N
authors: Weintrob
authors: Jacob
authors: J
authors: Amir
authors: Yaron
authors: Y
authors: Avitzur
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000311:Adrenal Glands / Q000502:physiology; D000309:Adrenal Insufficiency / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D013312:Stress, Physiological
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D000324:Adrenocorticotropic Hormone