825 Symptomatic glucocorticoid -induced adrenal suppression (AS) in the UK and Ireland- results of a BPSU study
Bibliographic record
Abstract
Objectives 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. Methods 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. Results 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. Conclusion The incidence of GC- induced AS of 0.1 per 100,000 young people is lower than other studies1 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. Reference Goldbloom EB, et al. Symptomatic adrenal suppression among children in Canada. Arch Dis Child 2017;102:340–5.
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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".