ESPEYB21 8. Adrenals Important for Clinical Practice (8 abstracts)
8.4. Incidence and risk factors for adrenal crisis in pediatric-onset adrenal insufficiency: a prospective study
Hosokawa M , Ichihashi Y , Sato Y , Shibata N , Nagasaki K , Ikegawa K , Hasegawa Y , Hamajima T , Nagamatsu F , Suzuki S , Numakura C , Amano N , Sasaki G , Nagahara K , Soneda S , Ariyasu D , Maeda M , Kamasaki H , Aso K , Hasegawa T & Ishii T
J Clin Endocrinol Metab. 2024; 109(8): e1602-e1607. https://pubmed.ncbi.nlm.nih.gov/38128002/
Brief Summary: This study examined the incidence and risk factors for adrenal crisis (AC) in patients with pediatric-onset adrenal insufficiency (AI). AC occurs in a substantial number of children with AI, particularly in younger children due to their high number of infections.
Comment: Adrenal crisis (AC) is a life-threatening complication in patients with adrenal insufficiency (AI) (1-4). The clinical features of AC are often nonspecific, and it may be unrecognized, especially in children. This can delay appropriate glucocorticoid treatment, and potentially result in death or irreversible brain damage (1, 5). Therefore, it is important to identify at-risk patients and intervene to prevent AC.
This multicenter, prospective cohort of patients diagnosed with AI at age ≤ 15 years in Japan, examined the incidence and risk factors for AC. Previous studies were retrospective. 349 patients (164 male, 185 female; median age: 14.3 years, interquartile range: 8.5-21.2 years) from 20 pediatric endocrinology clinics were recruited, and followed for 2.8 years (IQR 2.2-3.3 years). 213 patients (61%) had primary AI and 136 (39%) had secondary AI.
During the study period (2018-2022), physicians collected information on: height, weight, blood pressure, dose of glucocorticoids (GC) and mineralocorticoids (MC), presence or absence of fever, vomiting, diarrhea, surgery or trauma requiring stress dose of hydrocortisone (HC), and im or iv administration of HC. Overall, 41 episodes of AC occurred in 31 patients. In 40 events, iv HC was given at a medical institution; in only 1 event im HC was given at home (im HC self-injection was introduced in Japan in April 2020). The incidence of AC was 4.27 per 100 person years (PY). Among patients aged < 20 years, the incidence of AC was 6.58 per 100 PY. Risk factors for AC were: younger age at enrollment, and higher number of infections. Female sex, primary AI and GC dose were not significant risk factors.
This is the largest study to date on the incidence of AC in children with AI. The findings concur with previous retrospective studies and suggest that AC occurs in a substantial number of pediatric patients with AI. Particular attention should be given to younger children due to the increased incidence of infections.
References: 1. Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol. 2015; 172(3): R115-R124.2. Eyal O, Levin Y, Oren A, Zung A, Rachmiel M, Landau Z, Schachter-Davidov A, Segev-Becker A, Weintrob N. Adrenal crises in children with adrenal insufficiency: epidemiology and risk factors. Eur J Pediatr. 2019; 178(5): 731-738.3. Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010; 162(3): 597-602.4. Hahner S, Spinnler C, Fassnacht M, Burger-Stritt S, Lang K, Milovanovic D, Beuschlein F, Willenberg HS, Quinkler M, Allolio B. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab. 2015; 100(2): 407-416.5. Ishii T, Adachi M, Takasawa K, Okada S, Kamasaki H, Kubota T, Kobayashi H, Sawada H, Nagasaki K, Numakura C, Harada S, Minamitani K, Sugihara S, Tajima T. Incidence and characteristics of adrenal crisis in children younger than 7 years with 21-hydroxylase deficiency: a nationwide survey in Japan. Horm Res Paediatr. 2018; 89(3): 166-171.
Article tools
My recent searches
My recently viewed abstracts
Authors
ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more