33: Adrenal Suppression in the Pediatric Population in Canada
Bibliographic record
Abstract
Glucocorticoid (GC) therapy is effective for the treatment of many paediatric disorders. Hypothalamic-pituitary-adrenal axis suppression (‘adrenal suppression’ (AS)) is a proven but under-recognized side effect of GC use. The incidence of AS has not been established. AS may go undetected until a physiologic stress precipitates an adrenal crisis. To estimate the national incidence of paediatric adrenal crisis and symptomatic adrenal insufficiency due to AS in association with GC treatment, diagnosed by Canadian Paediatricians. To describe the clinical features of AS at diagnosis and to document burden of illness. To identify characteristics of children with symptomatic AS. To generate awareness among paediatricians of the frequency of AS and associated morbidity in children on GC therapy. Through the established methodology of the CPSP, >2500 paediatricians and paediatric subspecialists were actively surveyed monthly for two years to report new cases of symptomatic AS. Forty-four cases of symptomatic AS were confirmed. The estimated minimal annual incidence of symptomatic AS is 0.34 per 100,000 children aged 0 to 18 years (95% CI 0.25 to 0.45). Adrenal crisis occurred in six cases (14%). The most common presentations were growth failure (36%), non-specific symptoms (25%) and both growth failure and non-specific symptoms (14%). The predominant form of GC treatment in most cases was inhaled corticosteroids (ICS). Thirty-six children (82%) received ICS alone or in combination with other GC forms. The most commonly reported ICS was fluticasone (11 of 12 of those who received ICS only; 20 of 24 of those who received ICS in combination with other GC forms). Of the 11 children who received fluticasone only, doses were 500 mcg/day (n=7) or greater (n=4). Eight children (18%) received primarily systemic GCs. The minimal estimated incidence reported in our study is for the entire paediatric population and would be much higher in the at-risk group (ie, children treated with GCs). The lack of consistent, specific signs and symptoms for AS indicates that many cases may not be recognized without proactive screening. The high frequency of growth failure and/or non-specific symptoms at presentation underlines the importance of close monitoring of growth and potential symptoms associated with AS. The six cases of adrenal crisis demonstrate the potential morbidity associated with this condition. Many children received high but commonly prescribed doses of ICS. To reduce the risk of AS, physicians must be aware of the risk of AS, revisit GC doses frequently to ensure that patients are being treated with the lowest effective dose, and consider the cumulative GC dose. Further studies are needed to assess screening methods and to further evaluate risk factors and duration of suppression.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".