Screening and Management of Adrenal Suppression in Youth: A Pediatric Endocrinology Society Survey

Adrenal suppression is a potential side effect of glucocorticoid (GC) therapy. Timely diagnosis and management can significantly reduce morbidity and mortality from adrenal crisis. There is a need for pediatric-specific guidelines to provide non-endocrinologist GC prescribers with diagnostic and management tools to keep children and youth safe. This study aimed to assess adrenal suppression screening and management practices among surveyed pediatric endocrinology members of the Pediatric Endocrinology Society (PES) to support the need for national pediatric adrenal suppression guidelines.

A survey (19 questions, implied consent model), developed by members of the PES Adrenal Special Interest Group and the PES Drugs and Therapeutics Committee, was distributed to PES members.

Among 154 survey respondents, 90.9% were pediatric endocrinology attendings, predominantly working in the USA (91.6%) in an academic setting (86.4%). A majority (70.1%) have seen an adrenal crisis due to adrenal suppression. Only 48.1% of participants follow any pediatric adrenal suppression guidelines (within which 32.5% used a local guideline); 27.9% use adult guidelines. While 52.6% reported that adrenal suppression cases are managed by both endocrinologists and non-endocrinologists, only 38.3% of respondents provide resources to non-endocrinologists. Most screen for adrenal suppression with early morning cortisol (88.3%) or a low-dose ACTH stimulation test (55.8%). Notably, 8.4% of respondents believe that use of inhaled corticosteroids is not associated with a risk of adrenal suppression. Nearly all respondents (99.4%) agree that an official PES guideline on adrenal suppression would reduce morbidity and mortality by raising awareness and standardizing management.

Adrenal crisis due to adrenal suppression remains a preventable yet persistent threat. Screening and management practices vary widely among North American pediatric endocrinologists, underscoring the need for pediatric-specific guidelines. Establishing such guidelines would fill a critical care gap and promote a standardized approach to diagnosis and management across clinicians.