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Study: More than half of patients had adrenal suppression
Despite a gradual taper, more than half of patients had adrenal suppression following their discontinuation of glucocorticoids, according to recently published data.
“I hope that our study will draw attention to the fact that children are at high risk of adrenal suppression (AS) despite a gradual taper of glucocorticoid therapy and that AS can be prolonged,” Alexandra Ahmet, MD, assistant professor of endocrinology at the University of Ottawa, told Healio Rheumatology. “This finding should encourage clinicians to provide education about the risk of AS and stress coverage during illness, injury or surgery for children receiving [glucocorticoids] GC therapy and in those who have discontinued GC therapy until there is evidence of a normal [hypothalamic–pituitary–adrenal] HPA axis,” she said.
Ahmet and colleagues performed an observational cohort study to determine the frequency, duration and predictors of AS after a gradual taper of GC in 39 patients (mean age, 12.9 years) with rheumatologic conditions. Patients were no older than 16 years and discontinued GC after at least 4 weeks (median duration, 39.4 weeks). The researchers tested morning cortisol 4 weeks after the GC taper until it returned to normal. After it returned, the researchers discontinued GCs and performed a low-dose adrenocorticotropic hormone stimulation test (LDST).
Patients with AS comprised 54.8% of the cohort, of which 50% recovered after 7 months. Two patients had persistent AD after 1 year and one had it after 2 years.
The researchers concluded that stress steroids should be considered in children treated with long-term GCs, even after discontinuation.
“Clinicians should be screening for symptoms of AS when GC are discontinued and physiological daily GC therapy should be considered in children with possible AS, especially in the context of symptoms,” Ahmet said. – by Will Offit
Disclosure: Ahmet reports she received honorarium as a consultant and is member of an advisory board for Reveragen.