Journal Article

Symptomatic glucocorticoid-induced adrenal suppression in the United Kingdom and Ireland: a BPSU study

Cheetham, Tim, Drake, Amanda J, Kanthagnany, Sai-Kalyani, Pearce, Mark S, Barlow, H, Lane, LC, Wood, Claire L, Blair, Joanne C, Sachdev, Pooja

2025

Overview

ObjectiveTo determine the incidence and describe the presentation and management of unexpected symptomatic glucocorticoid-induced adrenal suppression (AS) in children and young people aged 0–15 years.Setting and designSurveillance study of symptomatic glucocorticoid (GC)-induced AS with supportive biochemical evidence or presenting as an adrenal crisis, reported via the British Paediatric Surveillance Unit (BPSU) from September 2020 to September 2022.ResultsOver a 25-month period, 190 reports of symptomatic GC-induced AS/adrenal crisis were made, of which 22 were confirmed cases: 18 AS and 4 adrenal crises. This translates to an incidence rate of 0.09 new cases of GC-induced AS per 100 000 children aged 0–15 per year in the UK. There was a broad range of underlying diagnoses requiring GC prescription (16) and GC preparations (13). Of the 22 patients, 7 had more than 1 type of GC prescribed. The administration of oral GC occurred in 19 of the cases, inhaled GC use in 7, topical use in 5 and 1 case occurred after a single intramuscular injection of GC. All patients were discussed with a paediatric endocrinology team.ConclusionsThe incidence of AS from this UK-based BPSU study is lower than a similar Canadian study. This may indicate that paediatricians in the UK and Ireland are becoming more aware of the potential for GC-induced AS and thus are more proactive to prevent its occurrence. The clinical cases still highlight the need to educate families and healthcare professionals with a view to further reducing the morbidity and potential mortality associated with GC-induced AS.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Adolescent / Adrenal Insufficiency - chemically induced / Adrenal Insufficiency - diagnosis / Adrenal Insufficiency - epidemiology / Anorexia / Child / Child, Preschool / Consciousness / Crises / Eating Disorders / Endocrinology / Fatigue (Biology) / Female / Glucocorticoids / Glucocorticoids - administration & dosage / Glucocorticoids - adverse effects / Hormones / Humans / Hypoglycemia / Hyponatremia / Hypotension / Incidence / Infant / Infant, Newborn / Ireland - epidemiology / Male / Medical Services / Morbidity / Original research / Paediatrics / Pain / Patients / Pediatrics / Predominantly White Institutions / Pregnancy / Professional Education / Questionnaires / Reference Materials / Software / Statistics / Surveillance / United Kingdom - epidemiology / Vomiting