Abstract
The present review focuses on steroid-induced adrenal insufficiency (SIAI) in children and discusses the latest findings by surveying recent studies. SIAI is a condition involving adrenocorticotropic hormone (ACTH) and cortisol suppression due to high doses or prolonged administration of glucocorticoids. While its chronic symptoms, such as fatigue and loss of appetite, are nonspecific, exposure to physical stressors, such as infection and surgery, increases the risk of adrenal crisis development accompanied by hypoglycemia, hypotension, or shock. The low-dose ACTH stimulation test is generally used for diagnosis, and the early morning serum cortisol level has also been shown to be useful in screening for the condition. Medical management includes gradually reducing the amount of steroid treatment, continuing administration of hydrocortisone corresponding to the physiological range, and increasing the dosage when physical stressors are present.
Highlights
Adrenal insufficiency (AI) is defined as the inability of the adrenal cortex to produce sufficient amounts of glucocorticoid hormone
It should be noted that secondary and tertiary AI may be latent or their onset may often be slow; congenital AI may become apparent around puberty, while acquired AI can occur months to years after intracranial radiation [9] or traumatic brain injury [10,11]
This review focuses on the role of steroids, the most frequent etiology of tertiary AI [2], which induce iatrogenic adrenal insufficiency when the hypothalamic–pituitary–adrenal (HPA) axis is suppressed by high dosages or prolonged use of the drugs followed by abrupt discontinuation or rapid tapering
Summary
Adrenal insufficiency (AI) is defined as the inability of the adrenal cortex to produce sufficient amounts of glucocorticoid hormone. It can be associated with mineralocorticoid deficiency, depending on the pathophysiology of the disease [1]. AI is usually classified into the primary and secondary types, which are caused by adrenal diseases and hypothalamic/pituitary diseases, respectively. Craniopharyngiomas, adenomas, cysts Trauma, surgery, irradiation, pituitary apoplexy Lymphocytic hypophysitis, tuberculosis, meningitis Combined pituitary hormone deficiency, isolated ACTH deficiency. Besides the drug-induced etiologies described below, acquired secondary AI can be caused by a tumor (e.g., craniopharyngioma), trauma, surgery, inflammation, or infarction involving the pituitary gland. Severe hypoglycemia in the neonatal period is rather exceptional and can be seen in congenital isolated ACTH deficiency caused by a TBX19 gene mutation [12]
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