Related Experiment Video
Updated: Jul 5, 2025
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Adrenocortical suppression in children with nephrotic syndrome treated with corticosteroids
Ganesh M Krishna1, Aashima Dabas1, Mukta Mantan2
1Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Insights
Children with nephrotic syndrome on alternate day steroids show high rates of adrenal insufficiency. A cumulative steroid dose over 0.22 mg/kg/day indicates a risk for adrenocortical suppression.
Area of Science:
- Pediatric Endocrinology
- Pediatric Nephrology
- Endocrinology
Background:
- Children with nephrotic syndrome often receive prolonged alternate-day steroid therapy.
- This necessitates evaluating potential adrenocortical suppression using the adrenocorticotropic hormone (ACTH) stimulation test.
Purpose of the Study:
- To determine the prevalence of adrenocortical suppression in children with nephrotic syndrome on alternate-day steroids.
- To identify a predictive threshold for steroid dosage associated with adrenal insufficiency.
Main Methods:
- A cross-sectional study included 52 children (2-18 years) with steroid-sensitive or resistant nephrotic syndrome in remission.
- Adrenocortical function was assessed via baseline and post-ACTH stimulation serum cortisol levels.
- Adrenal insufficiency was diagnosed if 1-hour post-ACTH cortisol was <18.0 µgm/dl.
Main Results:
- The study found a 50% prevalence of adrenal insufficiency using baseline cortisol and 64% using post-stimulation levels.
- A cumulative annual prednisolone dose of >0.22 mg/kg/day predicted adrenocortical suppression with an AUC of 0.76.
- The predictive model demonstrated 63.9% sensitivity and 81.3% specificity.
Conclusions:
- A significant proportion of children with nephrotic syndrome exhibit adrenal insufficiency when treated with alternate-day steroids.
- Cumulative steroid intake exceeding 0.22 mg/kg/day on an alternate-day basis is a risk factor for predicting adrenocortical suppression.
Background:
Children with nephrotic syndrome are exposed to alternate day steroids for prolonged periods and this poses the need for evaluation of adrenocortical suppression using the adrenocorticotropic hormone (ACTH) stimulation test.
Methods:
This cross-sectional study enrolled children (2-18 years) both with steroid sensitive nephrotic syndrome (SSNS) (n = 27) and steroid resistant (SRNS) (n = 25); those on daily prednisolone or having serious bacterial infections or hospitalized were excluded. The primary objective was to determine prevalence of adrenocortical suppression in those on low dose alternate day steroids for more than 8 weeks or having received > 2 mg/kg/d for > 2 weeks in the past 1 year and currently in remission. A baseline morning fasting sample of serum cortisol was taken and 25 IU of ACTH (Acton Prolongatum*) injected intramuscularly and repeat serum cortisol sample taken after 1 h. All patients with 1 h post ACTH cortisol < 18.0 µgm/dl were diagnosed with adrenal insufficiency. Receiver operating characteristic curve was drawn to predict the prednisolone dose for adrenal insufficiency.
Results:
Fifty-two (33 males) children were enrolled (mean age 9.4 years); proportion of adrenal insufficiency was 50% and 64% using baseline and post stimulation cutoffs. The total cumulative annual dose of prednisolone 0.22 mg/kg/day predicted adrenocortical suppression with AUC 0.76 (95% CI 0.63-0.89), with sensitivity of 63.9% and specificity of 81.3%.
Conclusions:
A significant proportion of children with nephrotic syndrome were detected with adrenal insufficiency on ACTH stimulation test. A cumulative steroid intake of > 0.22 mg/kg/day on an alternate day basis emerged as a risk factor for predicting adrenocortical suppression.
More Related Videos
Related Concept Videos
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:31Hormones of the Adrenal Glands
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics