Symptomatic adrenal suppression among children in Canada
- 9 November 2016
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 102 (4), 338.1-339
- https://doi.org/10.1136/archdischild-2016-311223
Abstract
Background: Adrenal suppression (AS) is an under-recognised side effect of glucocorticoid (GC) use. AS may go undetected until a physiological stress precipitates an adrenal crisis. The incidence of AS has not been established. We sought to estimate the minimum national incidence and presenting features of paediatric symptomatic AS.Methods: Through the established methodology of the Canadian Paediatric Surveillance Program, over 2500 paediatricians were surveyed monthly for 2 years (April 2010–March 2012) to report new cases of symptomatic AS.Results: Forty-six cases of symptomatic AS were confirmed. The estimated annual incidence is 0.35/100 000 children aged 0–18 years (95% CI 0.26 to 0.47). The most common presentations were growth failure (35%), non-specific symptoms (28%) or both (13%). Adrenal crisis occurred in six cases (13%). Thirty-seven children (80%) had received inhaled corticosteroid (ICS) alone or in combination with other GC forms. Many children received high but commonly prescribed doses of ICS.Conclusions: AS is responsible for significant morbidity in children, including susceptibility to adrenal crisis. The minimal estimated incidence reported is for the entire paediatric population and would be much higher in the at-risk group (ie, children treated with GCs). Close monitoring of growth and possible symptoms of AS, which may be non-specific, are important in children on all forms of GC therapy including ICS. To reduce the risk of AS, physicians must be aware of the risk of AS, revisit GC doses frequently and use the lowest effective dose.Keywords
Funding Information
- Physicians' Services Incorporated Foundation (11-07)
This publication has 32 references indexed in Scilit:
- Screening for hypothalamic–pituitary–adrenal axis suppression in asthmatic children remains problematic: a cross-sectional studyBMJ Open, 2013
- Hypothalamic-Pituitary-Adrenal Axis Suppression in Asthmatic School ChildrenPediatrics, 2012
- Moderate Dose Inhaled Corticosteroid-Induced Symptomatic Adrenal SuppressionClinical Pediatrics, 2012
- Adrenal suppression: A practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapyAllergy, Asthma & Clinical Immunology, 2011
- Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseasesActa Paediatrica, 2010
- Pitfalls in the Diagnosis of Central Adrenal Insufficiency in ChildrenEndocrine development, 2009
- Reappraisal of Astigmatism Induced by Periocular Capillary Hemangioma and Treatment with Intralesional Corticosteroid InjectionOphthalmology, 2008
- Fatal and near-fatal encephalopathy with hyponatraemia in two siblings with fluticasone-induced adrenal suppressionActa Paediatrica, 2007
- Cushing syndrome, adrenal suppression and local corticosteroid useJournal of Paediatrics and Child Health, 2006
- Clinical Impact of Corticosteroid-Induced Adrenal Suppression during Treatment for Acute Lymphoblastic Leukemia in Children: A Prospective Observational Study Using the Low-Dose Adrenocorticotropin TestThe Journal of Pediatrics, 2005