Screening for adrenal suppression in children with inflammatory bowel disease discontinuing glucocorticoid therapy

Marianne Sidoroff,Kaija-Leena Kolho

doi:10.1186/1471-230x-14-51

Abstract

BackgroundPharmacological doses of corticoids may result in adrenal suppression but with individual sensitivity. In paediatric inflammatory bowel disease (IBD), glucocorticoids are needed in the majority of the patients but there are less studies related to tapering off the drugs. The objective of this study was to estimate the frequency of adrenal insufficiency in children with IBD that were at the end of their systemic glucocorticoid therapy course.MethodsThe study was a retrospective case series of 59 consecutive paediatric IBD patients (median age 14.1 years; Crohn’s disease n = 22, ulcerative colitis n = 26, unclassified colitis n = 11) that were on oral prednisolone therapy about to be discontinued. The study patients were treated in a tertiary university hospital setting. Serum morning cortisol was measured with Immulite 2000 cortisol kit. Values < 20 nmol/l are undetectable and indicate adrenal suppression, values > 69 nmol/l are considered to represent normal basal secretion.ResultsThe morning cortisol was below the reference range in 20% of the patients and undetectable in 10%. Low cortisol levels associated with higher daily glucocorticoid doses (median 7.2 mg/m2 vs. 3.0 mg/m2 in patients with normal cortisol levels, p < 0.05) and with the long duration of the treatment (median 11 months vs. 4 months, p < 0.05). Patients with undetectable cortisol levels recovered within few weeks (median 5.6 weeks).ConclusionsIn paediatric IBD prolonged courses of glucocorticoids are frequent due to the steroid-dependent nature of the disease in a considerable proportion of patients. Adrenal suppression may occur in at least one fifth of the patients despite slowly tapering off the glucocorticoids. Notably, this is based on a set of serum cortisol measurements by request of experienced clinicians. All paediatric IBD patients receiving conventional doses of oral glucocorticoids should be subjected to screening for adrenal suppression when anticipated discontinuation of the drug.

Highlights

Pharmacological doses of corticoids may result in adrenal suppression but with individual sensitivity
We found that in 20% of the patients the morning cortisol measurement was below the reference range and low cortisol values associated with higher daily glucocorticoid doses and longer duration of the therapy
In conclusion, this study shows that at least every fifth paediatric inflammatory bowel disease (IBD) patient presents with abnormal or even undetectable serum cortisol values at the end of systemic glucocorticoid treatment

Summary

Introduction

Pharmacological doses of corticoids may result in adrenal suppression but with individual sensitivity. The number of children suffering from IBD has risen during the past decades and in Western countries its incidence is growing with an alarming pace [1,2,3,4]. The reason for this increase is at present unknown. Adrenal suppression is a condition in which adrenal glands do not produce adequate amounts of cortisol in response to physiological stress. It is caused by the suppression of the hypothalamic-pituitary-adrenal (HPA) axis by the circulating exogenous glucocorticoids and may lead into adrenal crisis or even death [10]

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