Symptomatic adrenal suppression among children in Canada

Area of Science:

• Pediatric Endocrinology
• Pharmacovigilance
• Endocrinology

Background:

• Adrenal suppression (AS) is an under-recognized adverse effect of glucocorticoid (GC) therapy.
• AS can lead to adrenal crisis, particularly during physiological stress.
• The incidence of pediatric symptomatic AS has not been previously established.

Purpose of the Study:

• To estimate the minimum national incidence of symptomatic pediatric adrenal suppression.
• To identify the common presenting features of symptomatic pediatric AS.
• To raise awareness of AS as a significant side effect of GC use.

Main Methods:

• Utilized the Canadian Paediatric Surveillance Program methodology.
• Surveyed over 2500 pediatricians monthly for two years (April 2010-March 2012).
• Collected reports of new cases of symptomatic pediatric AS.

Main Results:

• Confirmed 46 cases of symptomatic AS.
• Estimated annual incidence of 0.35 per 100,000 children (0-18 years).
• Common presentations included growth failure (35%), non-specific symptoms (28%), or both (13%); 13% experienced adrenal crisis. 80% received inhaled corticosteroids (ICS).

Conclusions:

• Symptomatic AS causes significant morbidity in children, including adrenal crisis risk.
• The estimated incidence is minimal for the general pediatric population; higher in GC-treated children.
• Monitoring growth and non-specific AS symptoms is crucial for children on GCs, including ICS. Physicians should minimize GC doses.