Kapila Anoushka, Singh Aaradhana, Raizada Nishant, Aggarwal Anju
Department of Pediatrics, Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Department of Diabetes, Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India.
Indian J Endocrinol Metab. 2025 Jul-Aug;29(4):423-428. doi: 10.4103/ijem.ijem_12_25. Epub 2025 Aug 26.
Glucocorticoid-induced adrenal insufficiency (AI) is underestimated and under-reported in children with nephrotic syndrome (NS). This study aimed to estimate the prevalence of AI in children with steroid-sensitive NS, defined by serum cortisol level <18 mcg/dL 30 minutes after low-dose adrenocorticotropin stimulation test (LDST) and/or baseline (8 AM) serum cortisol level <5 mcg/dL, 4-12 weeks after stopping steroid therapy.
In this cross-sectional study, 73 children with steroid-sensitive NS, in remission and off steroids for 4-12 weeks, were enrolled from the Paediatrics Department at a tertiary care hospital. Baseline (8 AM) serum cortisol was measured, and LDST was done using 1 mcg tetracosactide acetate intravenously. The proportion of AI was calculated. Clinical features of AI and steroid toxicity were noted, and the association between the two was analysed.
Out of 73 children (45 males), 52 (71.2%, 95% confidence interval: 59.3%-80.9%) had AI as defined by serum cortisol level <18 mcg/dL 30 min after LDST and/or baseline (8 AM) serum cortisol level <5 mcg/dL at 4-12 weeks after completion of steroid therapy. A strong positive correlation was observed between 8 AM baseline serum cortisol levels and post-LDST serum cortisol levels. Children exhibiting features of steroid toxicity, such as cushingoid facies, had 4.96 times higher odds of having AI.
There remains a high risk of AI even 4-12 weeks after completion of alternate-day steroid therapy in children with NS. Clinical features of steroid toxicity may serve as useful predictors of AI.
糖皮质激素诱导的肾上腺功能不全（AI）在肾病综合征（NS）患儿中被低估且报告不足。本研究旨在评估激素敏感型NS患儿中AI的患病率，其定义为在小剂量促肾上腺皮质激素刺激试验（LDST）后30分钟血清皮质醇水平<18 mcg/dL和/或在停用类固醇治疗4至12周后基线（上午8点）血清皮质醇水平<5 mcg/dL。
在这项横断面研究中，从一家三级护理医院的儿科招募了73名处于缓解期且停用类固醇4至12周的激素敏感型NS患儿。测量基线（上午8点）血清皮质醇，并静脉注射1 mcg醋酸二十四肽促皮质素进行LDST。计算AI的比例。记录AI和类固醇毒性的临床特征，并分析两者之间的关联。
在73名儿童（45名男性）中，52名（71.2%，95%置信区间：59.3%-80.9%）符合AI的定义，即在LDST后30分钟血清皮质醇水平<18 mcg/dL和/或在完成类固醇治疗4至12周后基线（上午8点）血清皮质醇水平<5 mcg/dL。上午8点基线血清皮质醇水平与LDST后血清皮质醇水平之间观察到强正相关。表现出类固醇毒性特征（如库欣面容）的儿童患AI的几率高4.96倍。
即使在NS患儿隔日类固醇治疗完成后4至12周，AI的风险仍然很高。类固醇毒性的临床特征可能是AI的有用预测指标。
