{
  "abstract": "Adrenal insufficiency (AI) is a recognized complication following systemic steroid therapy in paediatric patients, including inflammatory bowel disease (IBD). 1 5 Nevertheless, review of guidelines from relevant societies (BSPGHAN, ESPGHAN, and ECCO) shows no formal, standardised management pathway for monitoring AI in these patients. This study aims to identify possible risk factors for AI in children with IBD receiving systemic (intravenous or oral) steroid therapy, and to propose a screening and management protocol. Between June 2022 and June 2024, this single-centre, prospective study evaluated 9 children with IBD receiving more than two courses of systemic steroids out of 100 patients cared for within this time frame. Eight patients were investigated, six of whom had a low early morning free cortisol level suggestive of AI. No correlation was observed between insufficient early morning cortisol level and type of IBD, clinical characteristics at diagnosis, type or dosing of the systemic steroid treatment received (table 1). Within this group, symptoms were nonspecific or absent, emphasizing the difficulty of predicting AI without screening. Children in this group were treated with supplemental oral hydrocortisone and were followed up 3 monthly. By the end of the observation period, 1/6 children had regained a sufficient cortisol level after 8 months. In line with the most recent NICE guidelines highlighting a risk for AI in children receiving more than 3 weeks of systemic steroids,4 we have identified a relevant prevalence in this study population similar to previous studies1–3 and therefore support recommendation for AI screening via early morning cortisol level in this context (figure 1). We recognise the limitation of small numbers in this study and aim for a multi-centric collaboration on a national level to develop a comprehensive pathway based on the one proposed here.Abstract OC59 Table 1Patient data from our study Patient Status Number of Patients Steroid Type Starting steroid Dosage (mg/m²) Courses of Steroids (more than 3 weeks) Symptoms Type of IBD Age at diagnosis of IBD A1a: 0 to < 10 yrs A1b: 10 to < 17 yrs Adrenal Insufficient 6 IV hydrocortisone/oral prednisolone 20–48 2–8 Tiredness, body aches, no symptoms. CD n=2IBD-U n=2UC n=2 A1a n=4A1b n=2 Adrenal Sufficient 2 IV hydrocortisone/oral prednisolone 25–30.7 2–3 Weakness, dizziness, low energy, or no symptoms CD n=1UC n=1 A1a n=0A1b n=2 Table 1 Legend: CD: Crohn’s disease; IBD-U: inflammatory bowel disease unclassified; IV: intravenous; UC: ulcerative colitis.Suggested pathway for investigating and managing AI post steroid therapy Abstract OC59 Figure 1References Sidoroff M, Kolho K. Screening for adrenal suppression in children with inflammatory bowel disease discontinuing glucocorticoid therapy. BMC Gastroenterology. 2014;14:51–55.Chatzidaki V, et al. Incidence of secondary adrenal suppression after prolonged use of glucocorticoid therapy in children with inflammatory bowel disease. Frontline Gastroenterology 2021. DOI:10.1136/flgastro-2021-bspghan.38Chadokufa SN, et al. Iatrogenic adrenal insufficiency upon discontinuation of glucocorticoid treatment in children and adolescent patients with inflammatory bowel disease: to screen or not to screen? Frontline Gastroenterology 2024;15(Suppl 1):A18-A19.Adrenal insufficiency – investigation and management. NICE guidelines 2024.Worth C, Linder J, El-Dahr S, et al. Acute illness and death in children with adrenal insufficiency. Front Endocrinol (Lausanne). 2021;12:742938. doi:10.3389/fendo.2021.742938.",
  "authors": [
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Madhuvanthi Dhamodaran"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Karen Blair"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Mary-Anne Morris"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Sue Underhill-Smith"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Eleanor Goodale"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Catharine Searle"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital"
      ],
      "name": "Marco Gasparetto"
    }
  ],
  "title": "OC59 Is adrenal insufficiency a risk in children with inflammatory bowel disease treated with systemic steroids? Our experience interpreted through NICE guideline",
  "uid": "f1db2520-911c-5f68-b8d1-8b8bc2d3691c"
}