title: Frequency and Duration of Adrenal Suppression Following Glucocorticoid Therapy in Children With Rheumatic Diseases.
abstract: Adrenal suppression (AS), a glucocorticoid (GC) side effect with potentially significant morbidity, is poorly understood. The purpose of our study was to determine frequency, duration, and predictors of AS following a gradual taper of GC in children with rheumatic conditions.
  
  
  
  A prospective, observational cohort study was conducted. All patients ages ≤16 years ready to discontinue GC after >4 weeks of therapy were included. Morning cortisol was tested 4 weeks after GC taper to physiologic doses and then repeatedly until normalization. GCs were subsequently discontinued and a low-dose adrenocorticotropic hormone stimulation test was performed.
  
  
  
  The study was completed by 31 of 39 patients. The median age was 12.9 years and median duration of GC therapy was 39.6 weeks. Seventeen patients (54.8%) had AS. Of the patients with AS, 50% showed recovery by 7 months. Two patients had persistent AS at 12 months and 1 patient at 2 years. A higher maximum GC dose was a significant predictor for the development of AS.
  
  
  
  More than 50% of our patients had AS after GC discontinuation, despite a gradual taper of GC. Stress steroids should be considered in children treated with long-term GC, even after steroid discontinuation, to prevent possible adrenal crisis.
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ahmet
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Brienza
authors.affiliation: Queen's University, Kingston, Ontario, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Tran
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Lemieux
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Aglipay
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ciaran
authors.initials: C
authors.lastname: Duffy
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Johannes
authors.initials: J
authors.lastname: Roth
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Roman
authors.initials: R
authors.lastname: Jurencak
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000097:blood* / Q000139:chemically induced* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone