Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit

Abstract

Introduction

Glucocorticoids are commonly used in pediatric critical illness and may lead to subsequent adrenal insufficiency, causing morbidity among pediatric intensive care unit (PICU) survivors. We aimed to determine the prevalence of and risk factors for adrenal insufficiency among children who received glucocorticoids during PICU admission.

Methods

We conducted a retrospective cohort study using structured medical record review to determine the prevalence of adrenal insufficiency and clinical characteristics of PICU patients 0–18 years old who received enteral and/or parenteral glucocorticoids. Patients were consecutively admitted to an academic tertiary referral PICU over 2 years.

Results

Among 530 patients who received glucocorticoids, 12 (2.3%) were diagnosed with adrenal insufficiency at a median of 55 (IQR 8-156) days after initial glucocorticoid exposure. Unadjusted analyses showed that patients with adrenal insufficiency were younger (median 0.5 vs 2 years, p = .020), had a longer PICU stay (79 vs 4 days, p < .001) and hospital stay (96 vs 6 days, p < .001), and had a lower survival rate at 1 year after PICU discharge (75% vs 94%, p = .033). There were no significant differences in sex, race/ethnicity, illness severity, or diagnostic categories. Patients with adrenal insufficiency were more likely to have received glucocorticoids for hyperinflammation (21% vs 8%) and less likely for reactive airway disease (10% vs 26%) (p = .036), had a higher median total hydrocortisone equivalent dose (2508 vs 480 mg, p = .007), and were more likely to have had a steroid taper (48% vs 24%, p = .003). Multivariable logistic regression showed no significant associations between clinical characteristics and the diagnosis of adrenal insufficiency.

Conclusions

Among PICU patients who received glucocorticoids, 2.3% were subsequently diagnosed with adrenal insufficiency. We identified potential risk factors for adrenal insufficiency after glucocorticoid use in the PICU, which warrant future study to better delineate and mitigate adrenal insufficiency's contribution to morbidity and mortality among critically ill children.