ESPE2022 Poster Category 1 Adrenals and HPA Axis (52 abstracts)
Glucocorticoid-induced adrenal insufficiency: morning plasma cortisol values safely assess recovery of the HPA axis in pediatrics
Margaux Laulhé , Cécile Dumaine , Didier Chevenne , Fallou Leye , Albert Faye , Blandine Dozières , Marion Strullu , Jérôme Viala , Julien Hogan , Véronique Houdouin , Juliane Léger , Dominique Simon , Jean Claude Carel , Caroline Storey , Sophie Guilmin-Crépon & Laetitia Martinerie
Robert Debré Hospital, Paris, France
Background and Objectives: Chronic administration of synthetic glucocorticoids affects 1% of the world population and is responsible for secondary adrenal insufficiency for 40% of the patients. In pediatrics, glucocorticoid-induced adrenal insufficiency (GI-AI) diagnosis is based on the Low Dose Synacthen Test (LD-SST). Screening for glucocorticoid-induced adrenal insufficiency implies medical and economical costs due to the necessity of an intravenous line and medical survey. As glucocorticoids are widely prescribed in pediatrics, we aimed to define morning cortisol thresholds to predict either normal or pathologic responses to the LD-SST in order to avoid unnecessary tests.
Methods: Data from patients aged from 6 months to 18 years old who underwent a LD-SST following administration of glucocorticoids for at least 3 weeks between 2016 and 2020 were recorded. According to the practices in our hospital, adrenal insufficiency was defined as a cortisol plasma level 20 minutes after 1µg of Synacthen inferior to 500 nmol/L.
Results: Of the 91 patients included, 60% were diagnosed with glucocorticoid induced adrenal insufficiency. Morning cortisol plasma levels were significantly associated with the results of LD-SST (ANOVA, P<0.0001). Using a ROC curve (AUC 0.78), we defined two thresholds of morning plasma cortisol levels. A morning plasma cortisol level under 144 nmol/l managed to predict GI-AI with a specificity of 94% whereas GI-AI can be ruled out when morning plasma cortisol value is superior to 317 nmol/l with a sensitivity of 95%.
Conclusions: Morning cortisol values can be a safe tool to screen adrenal insufficiency after prolonged glucocorticoid treatment in children. Utilization of those thresholds could avoid 50% of LD-SST.
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