Document Detail


Adrenal insufficiency after glucocorticoid withdrawal in children with rheumatic diseases.
MedLine Citation:
PMID:  20649769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM:  Glucocorticoids (GCs) are often used for the treatment of rheumatic disorders. However, doses are prescribed, which may suppress the hypothalamic-pituitary-adrenal (HPA) axis. After GC withdrawal, recovery of the HPA axis may be delayed putting the patient at risk for adrenal insufficiency. We assessed adrenal function and factors influencing adrenal responsiveness after termination of GC therapy in paediatric patients with rheumatic diseases.
METHODS:   Nineteen patients aged 2-15 years were followed clinically, and adrenal function was tested by low-dose adrenocorticotropic hormone test 1 month after GC withdrawal. In case of adrenal insufficiency by test, re-assessment was performed after 6 and 18 months.
RESULTS:   No signs or symptoms of adrenal insufficiency occurred in any of the patients during and after GC withdrawal. Biochemical examination revealed adrenal insufficiency in 32% (6/19) at 4 weeks and in 11% (2/19) at 20 months after GC withdrawal.
CONCLUSIONS:   In conclusion, current strategies to withdraw GC from paediatric patients with rheumatic diseases are safe. Routine adrenal function testing after GC therapy and withdrawal may not be needed considering the low risk but high number of patients treated with GCs. Nevertheless, awareness of the potential risk and information of patients and their caregivers are crucial to avoid adrenal crisis.
Authors:
Benedikt M Huber; Isabel B Bolt; Marie-Josèphe Sauvain; Christa E Flück
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  99     ISSN:  1651-2227     ISO Abbreviation:  Acta Paediatr.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  1889-93     Citation Subset:  IM    
Copyright Information:
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.
Affiliation:
Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenal Glands / drug effects*,  physiopathology
Adrenal Insufficiency / chemically induced*
Child
Child, Preschool
Female
Follow-Up Studies
Glucocorticoids / administration & dosage*,  adverse effects*
Humans
Hypothalamo-Hypophyseal System / drug effects
Male
Pituitary-Adrenal System / drug effects
Retrospective Studies
Rheumatic Diseases / drug therapy*
Risk
Treatment Outcome
Chemical
Reg. No./Substance:
0/Glucocorticoids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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