825 Symptomatic glucocorticoid -induced adrenal suppression (AS) in the UK and Ireland- results of a BPSU study
Notice bibliographique
Résumé
<h3>Objectives</h3> Paediatricians prescribe glucocorticoids (GC) for a range of conditions with an associated risk of suppression of the hypothalamo-pituitary adrenal axis. We assessed this clinical problem objectively using the British Paediatric Surveillance Unit (BPSU) methodology. We aimed to identify any patient under 16 years of age whose symptoms or signs partly or entirely reflected abnormally low endogenous adrenal cortisol production arising because of recent or ongoing GC administration (adrenal suppression, AS). Specific study aims were to: Determine incidence of GC-induced AS Describe characteristics of patients developing AS including adrenal crisis Gauge how this was managed Determine whether there were factors that might prevent patients from becoming unwell in future. <h3>Methods</h3> This prospective BPSU study was conducted between September 2020 and September 2022 using monthly reporting cards sent to all paediatricians in the UK and Ireland. Once the study team were informed of a case, an electronic questionnaire was sent and information collected online using RedCAP software. Responses were evaluated by a multi-centre study team. Data was included on those with symptomatic adrenal suppression with supportive biochemical evidence (Low morning cortisol or suboptimal Synacthen test.) Infants less than 6 months of age who were born preterm (<37 weeks gestation) were excluded. <h3>Results</h3> 19 cases of AS and 1 adrenal crisis were identified, giving an estimated annual incidence of 0.1 cases per 100,000 0–15 year olds. Case characteristics are shown in table 1. Asthma was the most prevalent condition for which GC were prescribed. The presentations of AS included lethargy/extreme fatigue in 13 cases (68%), infections in 6 (32%), hyponatraemia in 4 (21%), hypotension in 3 (16%), and hypoglycaemia in 2 (11%). 1 patient presented in adrenal crisis. The majority of patients were subsequently commenced on replacement GC and gradually weaned with subsequent biochemical re-testing. <h3>Conclusion</h3> The incidence of GC- induced AS of 0.1 per 100,000 young people is lower than other studies<sup>1</sup> and suggests that paediatricians in the UK and Ireland are aware of the potential for this problem to develop and take steps to prevent this. This study highlights, nevertheless, the wide variety of conditions, routes of GC and the broad spectrum of symptoms and signs that can develop in patients with AS. There is scope to further educate families and healthcare professionals with a view to reducing the likelihood of patients developing symptoms due to AS. <h3>Reference</h3> Goldbloom EB,<i> et al</i>. Symptomatic adrenal suppression among children in Canada. <i>Arch Dis Child</i> 2017;<b>102</b>:340–5.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».