The online version of this article (doi:10.1186/1471-230X-14-51) contains supplementary material, which is available to authorized users.
The authors have no financial, professional or personal conflicts of interest relevant to the manuscript.
MS participated in the planning of the study concept and design, analyzed the data and drafted the manuscript. KLK supervised the study, obtained funding and critically revised the manuscript. Both authors read and approved the final manuscript.
Pharmacological 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.
The 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.
The 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).
In 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.
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG: Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012, 142: 46-54. 10.1053/j.gastro.2011.10.001. CrossRefPubMed
Chouraki V, Savoye G, Dauchet L, Vernier-Massouille G, Dupas J-L, Merle V, Laberenne JE, Salomez JL, Lerebours E, Turck D, Cortot A, Gower-Rousseau C, Colombel JF: The changing pattern of Crohn’s disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007). Aliment Pharmacol Ther. 2011, 33: 1133-1142. 10.1111/j.1365-2036.2011.04628.x. CrossRefPubMed
Wilson D, Thomas A, Croft N, Newby E, Akobeng AK, Sawczenko A, Fell JM, Murphy MS, Beattie RM, Sandhu BK, Mitton SG, IBD Working Group of the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition, Casson D, Elawad M, Heuschkel R, Jenkins H, Johnson T, Macdonald S, Murch SH: Systematic Review of the Evidence Base for the Medical Treatment of Paediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2010, 50 (1): 14-34. CrossRef
Turner D, Levine A, Escher JC, Griffiths AM, Russell RK, Dignass A, Dias JA, Bronsky J, Braegger CP, Cucchiara S, De Ridder L, Fagerberg UL, Hussey S, Hugot JP, Kolacek S, Kolho KL, Lionetti P, Paerregaard A, Potapov A, Rintala R, Serban DE, Staiano A, Sweeny B, Veerman G, Veres G, Wilson DC, Ruemmele FM, European Crohn’s and Colitis Organization; European Society for Paediatric Gastroenterology, Hepatology, and Nutrition: Management of Pediatric Ulcerative Colitis: Joint ECCO and ESPGHAN Evidence-based Consensus Guidelines. J Pediatr Gastroenterol Nutr. 2012, 55: 340-361. 10.1097/MPG.0b013e3182662233. CrossRefPubMed
Vernier-Massouille G, Balde M, Salleron J, Turck D, Dupas JL, Mouterde O, Merle V, Salomez JL, Branche J, Marti R, Lerebours E, Cortot A, Gower-Rousseau C, Colombel JF: Natural history of pediatric Corhn’s disease: a population-based cohort study. Gastroenterology. 2008, 135: 12106-1113. CrossRef
Miller WA, Achermann JC, Flück CE: The adrenal cortex and its disorders. Pediatric Endocrinology. 3rd edition. Edited by: Sperling MA. 2008, Philadelphia: Saunders, 444-511. CrossRef
Quax RA, Manenschijn L, Koper JW, Hazes J, Labberts SWJ, Van Rossum EFC, Feelders RA: Glucocorticoid sensitivity in health and disease. Nat Rew Endocrinol. 2013, 9: 670-686. 10.1038/nrendo.2013.183. CrossRef
Shulman DI, Palmert MR, Kemp SF, for the Lawson Wilkins Drug and Therapeutics Committee: Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics. 2007, 119: 484-494. 10.1542/peds.2006-1612. CrossRef
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, De Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A, Buderus S, Greer ML, Dias JA, Veereman-Wauters G, Lionetti P, Sladek M, Carpi JM, Staiano A, Ruemmele FM, Wilson DC: The ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents. J Pediatr Gastroenterol Nutr. 2013, Epub ahead of print
Turner D, Levine A, Escher JC, Griffiths AM, Russell RK, Dignas A, Amil Dias J, Bronsky J, Braegger C, Cucchiara S, De Ridder L, Fagerberg UL, Hussey S, Hugot J-P, Kolacek S, Kolho KL, Lionetti P, Paerregaard A, Potapov A, Rintala R, Serban DE, Staiano A, Sweeny B, Veerman G, Veres G, Wilson D, Ruemmele F: Management of pediatric ulcerative colitis: a joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr. 2012, 55: 340-361. 10.1097/MPG.0b013e3182662233. CrossRefPubMed
Tung J, Loftus EV, Freese DK, El-Youssef M, Zinsmeister AR, Melton LJ, Harmsen WS, Sandborn WJ, Faubion WA: A population-based study of the frequency of corticosteroid resistance and dependence in pediatric patients with Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2006, 12: 1093-1100. 10.1097/01.mib.0000235835.32176.85. CrossRefPubMed
Escher JC, European Collaborative Research Group on Budesonide in Paediatric IBD: Budesonide versus prednisolone for the treatment of active Crohn’s disease in children: a randomized, double-blind, controlled, multicentre trial. Eur J Gastroenterol Hepatol. 2004, 16: 47-54. 10.1097/00042737-200401000-00008. CrossRefPubMed
Rutgeerts P, Lofberg R, Malchow H, Lamers C, Olaison G, Jewell D, Ostergaard Thomsen O, Lorenz-Meyer H, Goebell H, Hodgson H, Persson T, Seidegård C: A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med. 1994, 331: 842-845. 10.1056/NEJM199409293311304. CrossRefPubMed
Schmidt IL, Lahner H, Mann K, Petersenn S: Diagnosis of adrenal insufficiency: Evaluation of the corticotropin-releasing hormone test and Basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic-pituitary-adrenal disease. J Clin Endocrinol Metab. 2003, 88: 4193-4198. 10.1210/jc.2002-021897. CrossRefPubMed
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