Journal article
Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
Journal of intensive care medicine, Vol.40(12), pp.1285-1291
12/2025
DOI: 10.1177/08850666251352447
PMID: 40567115
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
Details
- Title: Subtitle
- Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
- Creators
- Ashley N Radig - University of IowaVanessa A Curtis - University of IowaErik Westlund - Johns Hopkins UniversityChristina L Cifra - Boston Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of intensive care medicine, Vol.40(12), pp.1285-1291
- DOI
- 10.1177/08850666251352447
- PMID
- 40567115
- NLM abbreviation
- J Intensive Care Med
- ISSN
- 1525-1489
- eISSN
- 1525-1489
- Publisher
- Sage; THOUSAND OAKS
- Grant note
- National Center for Advancing Translational Sciences of the National Institutes of Health through the University of Iowa's Institute for Clinical and Translational Science: UL1TR002537
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The use of the REDCap platform for this work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR002537) through the University of Iowa's Institute for Clinical and Translational Science.
- Language
- English
- Electronic publication date
- 06/26/2025
- Date published
- 12/2025
- Academic Unit
- Endocrinology and Diabetes; Stead Family Department of Pediatrics; Internal Medicine
- Record Identifier
- 9984833489502771
Metrics
6 Record Views