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Frequency and Duration of Adrenal Suppression Following Glucocorticoid Therapy in Children With Rheumatic Diseases
Author(s) -
Ahmet Alexandra,
Brienza Vincent,
Tran Audrey,
Lemieux Julie,
Aglipay Mary,
Barrowman Nick,
Duffy Ciaran,
Roth Johannes,
Jurencak Roman
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23123
Subject(s) - medicine , discontinuation , glucocorticoid , adrenocorticotropic hormone , prospective cohort study , morning , cohort , adrenal crisis , adrenal insufficiency , pediatrics , hormone
Objective 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. Methods 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. Results 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. Conclusion 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.