Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST

• Published in: Frontiers in pediatrics Vol. 10; p. 981765
• Main Authors: Laulhé, Margaux, Dumaine, Cécile, Chevenne, Didier, Leye, Fallou, Faye, Albert, Dozières, Blandine, Strullu, Marion, Viala, Jérome, Hogan, Julien, Houdouin, Véronique, Léger, Juliane, Simon, Dominique, Carel, Jean-Claude, Storey, Caroline, Guilmin-Crépon, Sophie, Martinerie, Laetitia
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers 15.12.2022; Frontiers Media S.A
• Subjects: adrenal insufficency; cortisol; Endocrinology and metabolism; glucocorticoid withdrawal; Human health and pathology; Life Sciences; low dose short synacthen test; pediatric; Pediatrics; low dose short synacthen test; cortisol; adrenal insufficency; glucocorticoid withdrawal; pediatric
• ISSN: 2296-2360; 2296-2360
• DOI: 10.3389/fped.2022.981765

Glucocorticoid-induced adrenal insufficiency (GI-AI) is a common side effect of glucocorticoid therapy. However, its diagnosis currently relies on the realization of a Low Dose Short Synacthen Test (LD-SST) that requires an outpatient hospital and several blood samples. Our goal was to evaluate whether morning cortisol values could predict the response to LD-SST, in children, to avoid useless dynamic tests and facilitate diagnosis of glucocorticoid induced adrenal insufficiency. We recorded data of 91 pediatric patients who underwent a LD-SST in our center between 2016 and 2020 in a retrospective observational study. We selected LD-SST realized following administration of supra-physiologic doses of glucocorticoids during more than 3 weeks and performed at least four weeks after treatment was stopped. Adrenal deficiency was defined as a plasma cortisol concentration inferior to 500 nmol/l at LD-SST. Glucocorticoid-induced adrenal insufficiency was diagnosed in 60% of our cohort. Morning cortisol values were predictive of the response to the LD-SST (AUC ROC 0.78). A plasma cortisol concentration of less than 144 nmol/l predicted glucocorticoid induced adrenal insufficiency with a specificity of 94% and a value over 317 nmol/l predicted recovery of the HPA axis with a sensitivity of 95%. We did not find any other predictive factor for glucocorticoid-induced adrenal insufficiency. Morning cortisol values can safely assess recovery of the HPA axis in children treated chronically with glucocorticoids. Using these thresholds, more than 50% of LD-SST could be avoided in children.