Adrenal suppression with glucocorticoid therapy – still a problem after all these years?

Elizabeth Bayman, Amanda Drake

Research output: Contribution to journalEditorialpeer-review

Abstract / Description of output

Glucocorticoids are the mainstay of treatment for many conditions in childhood and their use in a wide variety of diseases means that many clinicians will prescribe steroids to and/or manage children on glucocorticoid therapy. However, all clinicians should be alert to the possibility that glucocorticoids can have significant side-effects, notably adrenal suppression. Chronic glucocorticoid treatment, through negative feedback on the hypothalamus/pituitary, leads to a reduction in hypothalamic corticotrophin-releasing hormone (CRH) and pituitary adrenocorticotrophic hormone (ACTH) production. Over weeks to months this can result in the progressive atrophy of cortisol producing cells in the adrenal gland, an inability to produce normal levels of cortisol in response to ACTH stimulation and secondary adrenal insufficiency (Figure 1). Patients with adrenal suppression may remain well if their normal glucocorticoid requirements are provided by the glucocorticoid treatment itself, however in some cases, this is inadequate and symptoms of adrenal insufficiency may occur (1). Furthermore, in the presence of adrenal atrophy, acute withdrawal of treatment (whether deliberate cessation of therapy or an inability to tolerate usual treatment) or the addition of an acute stressor, e.g. an intercurrent illness, in individuals who are unable to mount an appropriate cortisol response will lead to symptoms of adrenal insufficiency and potentially result in adrenal crisis. Importantly, adrenal suppression can persist for some time, so that full hypothalamic-pituitary-adrenal (HPA) axis recovery after stopping glucocorticoid therapy may take more than a year.
Original languageEnglish
JournalArchives of Disease in Childhood
Early online date22 Nov 2016
Publication statusE-pub ahead of print - 22 Nov 2016


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