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Updated: Jan 4, 2026
Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
Adrenal Insufficiency in Children With Eosinophilic Esophagitis Treated With Topical Corticosteroids
Paroma Bose1, Sanjay Kumar2, Todd D Nebesio3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children Indianapolis, IN.
Insights
Gastroenterologists rarely screen children with eosinophilic esophagitis (EoE) for adrenal insufficiency (AI). The study found a 5% AI prevalence in children on topical corticosteroids (TCS), suggesting DHEA-S may aid screening.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Endocrinology
Background:
- Topical corticosteroids (TCS) are a common treatment for eosinophilic esophagitis (EoE).
- Long-term TCS use in children may increase the risk of adrenal insufficiency (AI).
- Current screening practices for AI in pediatric EoE patients are not well-defined.
Purpose of the Study:
- To assess gastroenterologists' screening practices for AI in children with EoE treated with TCS.
- To determine the prevalence of AI in this pediatric population.
- To evaluate serum dehydroepiandrosterone sulfate (DHEA-S) as a potential screening tool for AI, comparing it with morning serum cortisol (MSC) levels.
Main Methods:
- A multi-part study involving a survey of gastroenterologists and prospective screening of pediatric EoE patients on TCS.
- Patients were screened using morning serum cortisol (MSC) levels; low levels prompted repeat testing or ACTH stimulation tests.
- Serum dehydroepiandrosterone sulfate (DHEA-S) levels were measured concurrently with MSC levels for correlation analysis.
Main Results:
- Only 7% of surveyed gastroenterologists reported screening for AI in pediatric EoE patients on TCS.
- Providers in EoE consortia were significantly more likely to screen for AI.
- In the prospective cohort (n=37), 5% of patients were diagnosed with AI, and 51% had low MSC levels. DHEA-S and MSC showed a moderate correlation (rs=0.44, P=0.03).
Conclusions:
- Gastroenterologists, particularly those not in EoE consortia, infrequently screen for AI in children with EoE on TCS.
- The prevalence of AI in this cohort was 5%.
- While DHEA-S shows moderate correlation with MSC, further research is needed to establish its utility as an AI screening tool in this population.
Objectives:
The aim of the study was to identify practices of gastroenterologists screening for adrenal insufficiency (AI) and report prevalence of AI in children with eosinophilic esophagitis (EoE) treated with topical corticosteroids (TCS); compare serum dehydroepiandrosterone sulfate (DHEA-S) levels to morning serum cortisol (MSC) levels as screening tool for AI.
Methods:
A multipart study was conducted. In part 1, a survey about screening practices for AI in children with EoE on TCS was sent to gastroenterologists belonging to a PedsGI listserv and to EoE consortia. In part 2, children with EoE on TCS for ≥6 months were prospectively screened for AI with MSC levels. For subjects with a MSC level of <10 μg/dL, a repeat MSC level and/or confirmatory adrenocorticotropic hormone (ACTH) stimulation testing was offered. AI was defined by peak serum cortisol level <18 μg/dL. In part 3, DHEA-S levels were drawn with MSC levels.
Results:
Seven percent (16/238) of gastroenterologists screened for AI. Providers in EoE consortia were more likely to screen than nonconsortia providers [9/21(43%) vs 7/217(3%); P = 0.0001]. Thirty-seven children were prospectively screened for AI, and 51% (19/37) had a low MSC level. Ten patients had a low-dose ACTH stimulation test (LDST) after 1 or more low MSC levels. Five percent (2/37) of patients were diagnosed with AI. DHEA-S and MSC levels had a moderate correlation (rs = 0.44, P = 0.03).
Conclusions:
Gastroenterologists belonging to EoE consortia were more likely to screen for AI. Prevalence of AI in our prospective cohort was 5%. DHEA-S has a moderate correlation with MSC levels, but more data is required to assess utility as a screening tool for AI.
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