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Effect of different corticosteroid regimens on hypothalamic-pituitary-adrenal axis and growth in juvenile chronic
Insights
Alternate-day corticosteroid therapy, particularly a single morning dose, supports growth and minimizes hypothalamic-pituitary-adrenal axis suppression in children with juvenile chronic arthritis. Daily corticosteroid use should be avoided.
Area of Science:
- Pediatric Endocrinology
- Rheumatology
- Pharmacology
Background:
- Juvenile chronic arthritis (JCA) management often involves corticosteroids, which can impact growth and the hypothalamic-pituitary-adrenal (HPA) axis.
- Assessing the effects of different corticosteroid regimens on linear growth and HPA axis function is crucial for optimizing treatment in children.
Purpose of the Study:
- To evaluate the impact of various corticosteroid regimens on linear growth and HPA axis function in children with JCA.
- To identify optimal corticosteroid dosing strategies that minimize adverse effects on growth and endocrine function.
Main Methods:
- Linear growth was monitored in 36 children with JCA.
- HPA axis function was assessed using insulin-induced hypoglycemia and resting cortisol levels in 20 children.
- Children were categorized into three groups based on their corticosteroid regimen: daily, alternate-day from initiation, and alternate-day with prior daily use.
Main Results:
- Children on daily corticosteroid therapy showed significant HPA axis suppression and impaired growth.
- Children on an alternate-day regimen from the start had satisfactory growth and no HPA axis suppression in most cases.
- Prior daily corticosteroid use, even with subsequent alternate-day therapy, did not show a clear pattern of HPA axis suppression or growth recovery.
Conclusions:
- Daily divided doses of corticosteroids are detrimental to growth and HPA axis function in children with JCA and should be avoided.
- An alternate-day regimen, ideally a single morning dose (up to 2 mg/kg), is recommended for its minimal impact on HPA function and growth.
- For severe JCA, a small single supplemental dose on the alternate day may be necessary without significantly compromising growth or HPA axis function.
Abstract:
Linear growth was recorded in 36 children with juvenile chronic arthritis. In 20, the hypothalamic-pituitary-adrenal axis (HPA axis) was assessed by insulin-induced hypoglycaemia, the results of which correlated well with resting cortisol levels. Three groups were identified according to type of corticosteroid regimen administered. Group 1 (6 children), receiving daily corticosteroid therapy, were clearly suppressed and failing to grow. Group 2 (13 children) had received an alternate-day regimen from the initiation of corticosteroid therapy; they were not suppressed and growth was satisfactory in 11. Group 3 (17 children) were receiving alternate-day therapy, but had had daily corticosteroid in the past; they showed no clear pattern of suppression or growth. Factors influencing the recovery of the HPA axis and resumption of growth were assessed. No difference was found in the individual growth of 7 children who commenced alternate-day therapy before the age of 5, compared with matched controls. It is suggested that daily divided doses of corticosteroid should not be used. Ideally, a single morning dose (up to 2 mg/kg) alternate-day regimen should be employed, as this regimen has minimal effects on HPA function and growth, even in young children. For very severe systemic features, it may be necessary to add a small single dose on the alternate day.