Abstract
Objective: To assess the prevalence and risk factors of adrenal insufficiency (AI) in children after kidney or liver transplantation, hospitalized for a physiological stress episode, and to identify patients that might be at risk of adrenal crises by clinical and laboratory parameters at admission.
Patients and Methods: Adrenal function was prospectively evaluated by standard (250 µg) adrenocorticotropin test in 48 kidney or liver transplant pediatric recipients admitted for a physiological stress episode. Data on cumulative steroid treatment and clinical and laboratory findings were collected.
Results: Thirty-two patients were receiving longterm corticosteroids treatment and 16 were not. Al was diagnosed in 11 patients: 10 (31.3%) on long-term treatment and in one (6.25%) untreated. The only risk factor for AI was a cumulative dose of corticosteroids of >0.15mg/kg/d in the last 6 months (p=0.02, odds ratio of 6.67 (95%CI: 0.97- 45.79)). There was no correlation between clinical or laboratory signs of adrenal crisis on admission and the presence of AI. None of the patients with AI who didn't receive stress dose (n=8) developed adrenal crisis.
Conclusion: AI is present in about third of children receiving prolonged corticosteroid treatment after kidney or liver transplantation. Clinical parameters on admission can not reliably identify patients with AI. Universal administration of a stress dose during physiological stress is not required, and careful selection of patients who do require steroid stress dose is recommended.
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Bilavsky, E., Dagan, A., Bilavsky, H. et al. 399 Adrenal Insufficiency During Physiological Stress in Children After Kidney or Liver Transplantation. Pediatr Res 68 (Suppl 1), 205 (2010). https://doi.org/10.1203/00006450-201011001-00399
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DOI: https://doi.org/10.1203/00006450-201011001-00399