Glucocorticoid induced adrenal suppression

BPSU surveillance of outcome of symptomatic glucocorticoid induced adrenal suppression commenced in September 2020. This study will estimate how many people are presenting to healthcare providers with adrenal suppression causing symptoms because of them currently or previously taking glucocorticoid medication; describe the characteristics of these patients; find out whether healthcare management differs from established guidelines; and see if there are identifiable factors in health professional or family practice that might prevent these patients from becoming unwell or reduce the severity of their illness in future.

Overview

Glucocorticoids (GC) are steroid hormones made by the adrenal glands that sit above the kidneys. Natural GCs are essential to keep the body working normally and to deal with the stress of trauma and infections.

GC medication is frequently used to treat diseases in children. GC medication can be applied to the skin, inhaled or swallowed as part of the treatment of many conditions such as eczema, asthma or arthritis. If the body absorbs large amounts of GC medication, then this can prevent the person from making natural GC. This inability to produce natural GC normally is called adrenal suppression (AS).

AS is a particular concern at the time of illness, when extra natural GC would normally be produced by the adrenal glands as part of the stress response. If additional GC is not administered at such times in patients with AS then they can become unwell with nausea, vomiting, low blood pressure, low glucose and altered consciousness. This is referred to as an adrenal crisis and can be fatal.

Health professionals and patients do not always remember that GC medicine can prevent natural GC production and that additional GC may be needed when someone is unwell. This inability to make natural GC normally can persist if someone has recently stopped GC medicine. We intend to look at how common it is for children to present unwell at hospital because of AS. This will help us to develop ways of managing patients more effectively and safely.

This study is designed to investigate how many children and young people (less than 16 years of age) have secondary AS and/or the associated adrenal crisis arising as a consequence of taking GC medication.

Investigators

Dr Tim Cheetham
Department of Paediatric Endocrinology
The Great North Children’s Hospital
Newcastle-upon-Tyne NE1 4LP
Email: tim.cheetham@nhs.net