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- Title
Frequency and Duration of Adrenal Suppression Following Glucocorticoid Therapy in Children With Rheumatic Diseases.
- Authors
Ahmet, Alexandra; Brienza, Vincent; Tran, Audrey; Lemieux, Julie; Aglipay, Mary; Barrowman, Nick; Duffy, Ciaran; Roth, Johannes; Jurencak, Roman
- Abstract
<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
DRUG therapy for rheumatism; RHEUMATISM diagnosis; GLUCOCORTICOIDS; HYDROCORTISONE; LONGITUDINAL method; RHEUMATISM; TIME; ADRENAL insufficiency; DIAGNOSIS
- Publication
Arthritis Care & Research, 2017, Vol 69, Issue 8, p1224
- ISSN
2151-464X
- Publication type
journal article
- DOI
10.1002/acr.23123