Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseases
Article first published online: 29 OCT 2010
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Pædiatrica
Volume 99, Issue 12, pages 1889–1893, December 2010
How to Cite
Huber, B. M., Bolt, I. B., Sauvain, M.-J. and Flück, C. E. (2010), Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseases. Acta Paediatrica, 99: 1889–1893. doi: 10.1111/j.1651-2227.2010.01936.x
- Issue published online: 29 OCT 2010
- Article first published online: 29 OCT 2010
- Received 12 April 2010; revised 25 May 2010; accepted 29 June 2010.
- Adrenal insufficiency;
- Glucocorticoid withdrawal;
- Low-dose ACTH test;
- Paediatric rheumatology
Aim: 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.