title: Screening for adrenal suppression in children with inflammatory bowel disease discontinuing glucocorticoid therapy.
abstract: BACKGROUND
  Pharmacological doses of corticoids may result in adrenal suppression but with individual sensitivity. In paediatric inflammatory bowel disease (IBD), glucocorticoids are needed in the majority of the patients but there are less studies related to tapering off the drugs. The objective of this study was to estimate the frequency of adrenal insufficiency in children with IBD that were at the end of their systemic glucocorticoid therapy course.
  
  
  METHODS
  The study was a retrospective case series of 59 consecutive paediatric IBD patients (median age 14.1 years; Crohn's disease n = 22, ulcerative colitis n = 26, unclassified colitis n = 11) that were on oral prednisolone therapy about to be discontinued. The study patients were treated in a tertiary university hospital setting. Serum morning cortisol was measured with Immulite 2000 cortisol kit. Values < 20 nmol/l are undetectable and indicate adrenal suppression, values > 69 nmol/l are considered to represent normal basal secretion.
  
  
  RESULTS
  The morning cortisol was below the reference range in 20% of the patients and undetectable in 10%. Low cortisol levels associated with higher daily glucocorticoid doses (median 7.2 mg/m(2) vs. 3.0 mg/m(2) in patients with normal cortisol levels, p < 0.05) and with the long duration of the treatment (median 11 months vs. 4 months, p < 0.05). Patients with undetectable cortisol levels recovered within few weeks (median 5.6 weeks).
  
  
  CONCLUSIONS
  In paediatric IBD prolonged courses of glucocorticoids are frequent due to the steroid-dependent nature of the disease in a considerable proportion of patients. Adrenal suppression may occur in at least one fifth of the patients despite slowly tapering off the glucocorticoids. Notably, this is based on a set of serum cortisol measurements by request of experienced clinicians. All paediatric IBD patients receiving conventional doses of oral glucocorticoids should be subjected to screening for adrenal suppression when anticipated discontinuation of the drug.
authors.forename: Marianne
authors.initials: M
authors.lastname: Sidoroff
authors.affiliation: Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki FI-00029, Finland. kaija-leena.kolho@helsinki.fi.
authors.forename: Kaija-Leena
authors.initials: KL
authors.lastname: Kolho
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000187:drug effects; D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D010865:Pilot Projects; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D006854:Hydrocortisone