Glucocorticoid stress dosing benefits children with congenital adrenal hyperplasia

In children with congenital adrenal hyperplasia (CAH), initiating glucocorticoid stress dosing by the patients and their families helps correct hyperkalaemia and reduce potassium levels, as shown in a study. However, the intervention may do little in terms of sodium and glucose concentrations or hypotension.

Researchers assessed the effect of prior self‐managed glucocorticoid dose escalation on physiological markers in paediatric CAH patients presenting to hospital for an acute illness. The analysis included 321 children (mean age, 4.5 years; 55.5 percent male) with CAH and acute illness who presented to the emergency department, among whom 206 (64.2 percent) administered stress dosing prior.

In the cohort, 11 children (3.4 percent) had hypotension, 78 (24.3 percent) had diarrhoea, 196 (61.1 percent) had vomiting, and 29 (9.0 percent) had an adrenal crisis. Those who were vs not hypotensive were older than patients who were not (mean age, 7.1 vs 4.4 years; p<0.05).

Use of glucocorticoid stress dosing (oral and/or intramuscular) led to a significantly lower potassium level (mean, 4.02 vs 4.27 mmol/l; p<0.05). Linear regression analysis revealed that potassium levels were significantly associated with age (beta, −0.04 years), diarrhoea (beta, −0.41), and any form of stress dosing (oral, IM, or both; beta −0.29). In contrast, stress dosing had a null effect on sodium or glucose concentrations or with estimates of hypotension.

The benefits from stress dosing were obtained even in the presence of diarrhoea, which is associated both with potassium loss and poorer absorption of oral glucocorticoids, the researchers said.

The present data provide novel evidence regarding the benefit of dose escalation recommendations and support continued efforts aimed at their universal application among patients with CAH during periods of physiological stress, they added.