The study’s goal was to identify gastroenterologists’ screening practises for adrenal insufficiency (AI) and to report the prevalence of AI in children with eosinophilic esophagitis (EoE) treated with topical corticosteroids (TCS); to compare serum dehydroepiandrosterone sulphate (DHEA-S) levels to morning serum cortisol (MSC) levels as a screening tool for AI. Multi-part research was carried out. Part 1 involved sending a survey on screening procedures for AI in children with EoE on TCS to gastroenterologists on a PedsGI listserv and EoE consortia. In phase 2, children with EoE who had been on TCS for 6 months were tested for AI with MSC levels. Subjects having an MSC level of 10 g/dL were offered a repeat MSC level and/or confirmatory adrenocorticotropic hormone (ACTH) stimulation testing. AI was characterised as having a peak serum cortisol level of 18 g/dL. Part 3 drew DHEA-S values beside MSC levels. Only 7% of gastroenterologists tested positive for AI. EoE consortia providers were more likely to screen than nonconsortia suppliers. Thirty-seven children were tested for AI in advance, and 51% had a low MSC level. Following one or more low MSC levels, ten patients underwent a low-dose ACTH stimulation test (LDST). AI was identified in 5% of the patients. The levels of DHEA-S and MSC exhibited a modest association.
Gastroenterologists who were members of EoE consortiums were more likely to screen for AI. The prevalence of AI in our prospective population was 5%. DHEA-S shows a modest association with MSC levels, but additional data is needed to determine its value as an AI screening tool.
Reference: https://journals.lww.com/jpgn/Fulltext/2020/03000/Adrenal_Insufficiency_in_Children_With.12.aspx
