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HPA axis recovered within 6 to 12 weeks of infant prednisolone therapy
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Infants demonstrated recovery of the hypothalamic-pituitary-adrenal axis within 6 to 12 weeks of glucocorticoid treatment, and circadian variation in salivary cortisol was also established within 6 weeks, according to data.
“This is much shorter than empirical recommendations to continue stress cover precautions for 6-12 months. Previous published data, mostly in adults, give conflicting information,” A. Czarina Mendoza-Cruz, BSc, MBBS(Hons), Dip.Paed, FRACP, of the department of endocrinology at the Sydney Children’s Hospital and the School of Women’s and Children’s Health at the University of New South Wales in Sydney, and colleagues wrote.
A. Czarina Mendoza-Cruz
Researchers in Australia measured the cortisol in serial saliva samples to examine the hypothalamic-pituitary-adrenal (HPA) axis recovery in otherwise healthy infants (n=12) who received a single course of high-dose prednisolone for the treatment of infantile hemangioma, matched with 10 healthy controls.
The infants were administered the high-dose oral prednisolone for 12 to 25 weeks, were weaned during 4 to 6 weeks, and therapy stopped by the time infants were aged 21 to 31 weeks. Circadian variation in salivary cortisol was also observed within 6 weeks (median, 2.7 weeks; range, 1.4-5.4 weeks) after cessation of high-dose prednisolone therapy, researchers wrote.
Synacthen confirmatory tests (1 mcg) administered within 12 weeks of completing prednisolone therapy appeared normal (peak serum cortisol >600 nmol/L), researchers added.
Further data indicate that healthy infants had circadian variation of salivary cortisol at a median age of 16.6 weeks (range, 8.2-24.4 weeks).
“Reduced duration of stress cover precautions may reduce parental anxiety and side effects from unnecessary glucocorticoid use,” researchers wrote.
Disclosure: This study was supported by a grant from the Australian Pediatric Endocrine Care by Pfizer. The researchers report no relevant financial disclosures.
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