Adrenal crisis was rare after glucocorticoid taper in children with nephrotic syndrome or juvenile idiopathic arthritis.
Study Design and Cohort
Investigators conducted a single center retrospective observational analysis at a tertiary pediatric hospital. Children from one month to under 16 years who received supraphysiological glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis were followed across 2,363 patient months. Treatment regimens were captured monthly, alongside systematic surveillance for emergency department visits, electrolyte derangements, clinical coding entries, and clinical team reports that could indicate adrenal crisis.
Adrenal Crisis Incidence and Timing
Across the cohort there were 974 patient months after glucocorticoids were discontinued and no adrenal crisis events were identified. During weaning, all patients with nephrotic syndrome and a subset with juvenile idiopathic arthritis transitioned to alternate day dosing after a modest period of daily supraphysiological therapy. Findings were compared with other published cohorts and the low adrenal crisis incidence did not appear to be explained by sample size limitations alone. The results suggest that careful tapering reduces the likelihood of clinically significant adrenal suppression at critical times.
Implications For Glucocorticoid Weaning
For children treated for nephrotic syndrome or juvenile idiopathic arthritis, supraphysiological glucocorticoids given for several weeks may be weaned and stopped safely without routine biochemical testing when supported by specialist pathways. Rapid access to team advice for families appears integral to safe implementation, particularly during intercurrent illness or stress dosing considerations. Alternate day regimens after initial daily therapy may help mitigate adrenal suppression while maintaining disease control.
Clinical Considerations for U.S. Practice
These data support structured taper protocols with clear family education and expedited clinician access. Pediatric services should confirm local escalation plans for suspected adrenal crisis and standardize wording in discharge instructions. Routine biochemical testing may be reserved for complex cases or prolonged exposure, while emphasizing symptom vigilance and stress dose guidance during febrile illness or surgery.
Reference: Finnie J et al. Incidence of adrenal crisis in children and young people receiving high dose glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis: a retrospective observational study. Arch Dis Child. 2025;doi:10.1136/archdischild-2025-328917.
