Archives of disease in childhood · 2026
Incidence of adrenal crisis in children and young people receiving high dose glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis: a retrospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Finnie James, Tse Yincent, Sampath Sunil, Alawad Hisham, Wood Claire Louise, Cheetham Tim
Аннотация
OBJECTIVE: To establish the incidence of adrenal crisis (AC) in patients treated with supraphysiological glucocorticoid (GC) for nephrotic syndrome (NS) or juvenile idiopathic arthritis (JIA) and hence at risk of adrenal suppression (AS).
DESIGN: Retrospective observational single centre study.
SETTING: Great North Children's Hospital, Newcastle upon Tyne.
PATIENTS: Children aged 1 month-<16 years, who received supraphysiological GC for NS or JIA within a defined period.
MAIN OUTCOME MEASURES: Monthly GC regimen and incidence of AC identified by reviewing: (1) clinic letters and emergency department attendance, (2) region wide electrolyte results, (3) clinical coding and (4) proactive discussion with respective clinical teams.
RESULTS: 97 patients were included, totalling 2363 patient months of follow-up. During GC weaning, all NS and 15% of JIA patients were switched to an alternate day GC regimen. A total of 974 patient months were observed following discontinuation of GC and no episodes of AC were identified. An assessment of AC events in other published cohorts indicated that the low incidence is not simply a reflection of poor sensitivity linked to sample size.
CONCLUSIONS: This study suggests that supraphysiological GC administered for several weeks can potentially be weaned and stopped safely without formal biochemical assessment in patients with NS and JIA. Specialist teams provide families with rapid access to advice which supports safe practice. An alternate day weaning regimen following a modest period of daily supraphysiological GC may have reduced the likelihood of AS at critical times.
DESIGN: Retrospective observational single centre study.
SETTING: Great North Children's Hospital, Newcastle upon Tyne.
PATIENTS: Children aged 1 month-<16 years, who received supraphysiological GC for NS or JIA within a defined period.
MAIN OUTCOME MEASURES: Monthly GC regimen and incidence of AC identified by reviewing: (1) clinic letters and emergency department attendance, (2) region wide electrolyte results, (3) clinical coding and (4) proactive discussion with respective clinical teams.
RESULTS: 97 patients were included, totalling 2363 patient months of follow-up. During GC weaning, all NS and 15% of JIA patients were switched to an alternate day GC regimen. A total of 974 patient months were observed following discontinuation of GC and no episodes of AC were identified. An assessment of AC events in other published cohorts indicated that the low incidence is not simply a reflection of poor sensitivity linked to sample size.
CONCLUSIONS: This study suggests that supraphysiological GC administered for several weeks can potentially be weaned and stopped safely without formal biochemical assessment in patients with NS and JIA. Specialist teams provide families with rapid access to advice which supports safe practice. An alternate day weaning regimen following a modest period of daily supraphysiological GC may have reduced the likelihood of AS at critical times.