P970 Iatrogenic adrenal insufficiency on discontinuation of glucocorticoid treatment in children and adolescent patients with inflammatory bowel disease: to screen or not to screen?

Abstract

Abstract Background Glucocorticoids are a mainstay of inflammatory bowel disease (IBD) treatment, with oral tapering courses frequently used to induce remission or limit flares. Iatrogenic adrenal insufficiency (AI), due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis is an established side effect of exogenous glucocorticoids. The rate of AI in this population is unknown. There is no standard guidance to suggest routine screening in paediatric IBD (pIBD). This study aimed to better understand the rates of AI with a screening and management protocol developed for pIBD patients given glucocorticoid therapy (GT) Methods All patients with IBD under 18 years treated with GT (prednisolone) for 3 weeks or longer from March 2022 to August 2023 were identified. Patients on other GT were excluded. Patients were screened for AI by serum early morning cortisol (Vitros Ortho Clinical Diagnostics immunoassay) and ACTH, and if indicated underwent standard short synacthen(SST) testing. Adrenal axis function was divided into normal allowing cessation of GT, or impaired response requiring hydrocortisone maintenance therapy (see figure1). A serum morning cortisol >250nmol/l indicated a normal adrenal axis; whereas dynamic adrenal axis testing was recommended for cortisol of 175-249 nmol/l. Those with cortisol <175nmol were diagnosed with AI and started on maintenance hydrocortisone. Repeat testing with SST was performed 3 monthly to reassess the adrenal-axis. Patients with an abnormal SST at the 6-month mark were referred to endocrinology Results 14 subjects were identified (8 male),7 with Ulcerative colitis, 4 with Crohn’s disease, 1 with IBD-U,2 with early-onset IBD. Median age at diagnosis was 10 years (range 8 months -14 years). Duration of GT was for an average 3 months (range 6 - 16 weeks). 42%(n=6) initiated GT with IV methylprednisolone before switching to 2mg/kg oral prednisolone (maximum 40mg) for 2 weeks, weaning 5mg every week. At the end of initial GT, morning cortisol was deficient in 42% (n=6), insufficient in 35% (n=5) requiring SST. Of those undergoing a SST at this stage, 60% (n=3) had a normal response, 40% (n=2) demonstrating AI. Overall, 57% (n=8) had significant AI at the end of initial treatment. Repeat adrenal axis testing was offered at 3 months (5 of 8) and at 6 months (4 of 4). AI was noted in 100% and 75% at 3 and 6-month respectively. No child suffered an adrenal crisis during the study period Conclusion AI following glucocorticoid therapy is common in this small cohort. Screening for AI should be considered in pIBD patients receiving conventional doses of glucocorticoids longer than 3 weeks, with appropriate advice given. The incidence and risks of iatrogenic adrenal insufficiency (AI) requires further investigation