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Hypothalamic-pituitary-adrenal axis recovery following prolonged prednisolone therapy in infants

A Czarina Mendoza-Cruz1, Orli Wargon, Susan Adams

  • 1Endocrinology, Sydney Children's Hospital, High Street, Randwick NSW 2031, Australia. c.verge@UNSW.edu.au.

The Journal of Clinical Endocrinology and Metabolism
|October 2, 2013
PubMed

Insights

Hypothalamic-pituitary-adrenal (HPA) axis suppression after prednisolone treatment in infants resolved within 6-12 weeks, shorter than recommended. Healthy infants established normal cortisol rhythms by 2-6 months, suggesting reduced stress cover duration is safe.

Area of Science:

  • Pediatric Endocrinology
  • Endocrinology
  • Pharmacology

Background:

  • The duration of hypothalamic-pituitary-adrenal (HPA) axis suppression following glucocorticoid therapy remains uncertain.
  • Infantile hemangiomas often require treatment with glucocorticoids like prednisolone.

Purpose of the Study:

  • To determine HPA axis suppression duration in infants treated with prednisolone.
  • To establish the age of circadian salivary cortisol rhythm in healthy infants.

Main Methods:

  • 12 infants with infantile hemangioma received high-dose prednisolone for 12-25 weeks, weaned over 4-6 weeks.
  • Serial salivary cortisol samples were collected until circadian variation was observed, confirmed by Synacthen tests.
  • 10 healthy controls had serial salivary cortisol measurements to determine the age of circadian rhythm establishment.

Main Results:

  • Circadian variation normalized within 6 weeks (median 2.7 weeks) of prednisolone cessation.
  • Confirmatory Synacthen tests were normal within 12 weeks of prednisolone cessation.
  • Healthy controls established circadian variation at a median of 16 weeks (range 8-24 weeks).

Conclusions:

  • HPA axis recovery occurred within 6-12 weeks, shorter than current empirical recommendations.
  • Reduced stress cover duration may decrease parental anxiety and unnecessary glucocorticoid side effects.
  • Healthy infants established circadian cortisol variation between 2 and 6 months of age.
Abstract

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