Hypothalamic-Pituitary-Adrenal Axis Recovery Following Prolonged Prednisolone Therapy in Infants

Mendoza-Cruz, Abel C; Wargon, Orli; Adams, Stacy A; Tran, Huy; Verge, Charles F.

doi:10.1210/jc.2013-2649

Cited by 15 publications

(19 citation statements)

References 20 publications

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“…However, if the duration of therapy is 3 weeks or longer, it is recommended that the glucocorticoid dose be tapered gradually to avoid precipitating symptoms of steroid dependence and/or AI 12. Protracted use of supraphysiological glucocorticoid doses may result in severe adrenal gland atrophy and prolonged AI lasting up to 34 weeks requiring glucocorticoid tapering to be extended over many months 13 14…”

Section: Etiologymentioning

confidence: 99%

“…Therefore, it is important to recognize chronic ICS therapy as a risk factor for AI. A study of infants with hemangiomas treated with high-dose glucocorticoid therapy for 12–26 weeks demonstrated the return of normal circadian response in salivary cortisol levels within 6 weeks and normal response to administration of low-dose ACTH stimulation by 12 weeks after stopping treatment 14…”

Section: Etiologymentioning

confidence: 99%

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Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Miller

Spencer

Geffner

et al. 2020

Journal of Investigative Medicine

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Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient’s HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient’s home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.

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Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Miller

Spencer

Geffner

et al. 2020

Journal of Investigative Medicine

View full text Add to dashboard Cite

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“…Mendoza-Cruz et al (6) looked into duration of HPA axis suppression in infants treated with prednisolone. The infants received high dose of prednisolone for an average of 3-6 months, weaned over 4-6 weeks.…”

Section: Glucocorticoid Use In Hemangiomamentioning

confidence: 99%

Recovery of steroid induced adrenal insufficiency

Younes

2017

Transl. Pediatr

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Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6-12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

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“…Some studies have demonstrated longer HPA-axis suppression during treatment of childhood ALL and brain tumors [101][102][103][104][105][106]. Changes in HPA-axis activity were shown to lead to learning and memory difficulties in animals [98].…”

Section: Hpa-axis Functioning: Hormonal Changes and Stressmentioning

confidence: 99%

Chemotherapy-induced neurotoxicity in pediatric solid non-CNS tumor patients: An update on current state of research and recommended future directions

Sleurs

Deprez

Emsell

et al. 2016

Critical Reviews in Oncology/Hematology

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Hypothalamic-Pituitary-Adrenal Axis Recovery Following Prolonged Prednisolone Therapy in Infants

Cited by 15 publications

References 20 publications

Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Recovery of steroid induced adrenal insufficiency

Chemotherapy-induced neurotoxicity in pediatric solid non-CNS tumor patients: An update on current state of research and recommended future directions

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