Adrenal Insufficiency after Steroid Therapy in Children with Steroid-Sensitive Nephrotic Syndrome: A Cross-sectional Study.

Introduction: Glucocorticoid-induced adrenal insufficiency (AI) is underestimated and under-reported in children with nephrotic syndrome (NS). This study aimed to estimate the prevalence of AI in children with steroid-sensitive NS, defined by serum cortisol level <18 mcg/dL 30 minutes after low-dose adrenocorticotropin stimulation test (LDST) and/or baseline (8 AM) serum cortisol level <5 mcg/dL, 4-12 weeks after stopping steroid therapy. Methods: In this cross-sectional study, 73 children with steroid-sensitive NS, in remission and off steroids for 4-12 weeks, were enrolled from the Paediatrics Department at a tertiary care hospital. Baseline (8 AM) serum cortisol was measured, and LDST was done using 1 mcg tetracosactide acetate intravenously. The proportion of AI was calculated. Clinical features of AI and steroid toxicity were noted, and the association between the two was analysed. Results: Out of 73 children (45 males), 52 (71.2%, 95% confidence interval: 59.3%-80.9%) had AI as defined by serum cortisol level <18 mcg/dL 30 min after LDST and/or baseline (8 AM) serum cortisol level <5 mcg/dL at 4-12 weeks after completion of steroid therapy. A strong positive correlation was observed between 8 AM baseline serum cortisol levels and post-LDST serum cortisol levels. Children exhibiting features of steroid toxicity, such as cushingoid facies, had 4.96 times higher odds of having AI. Conclusion: There remains a high risk of AI even 4-12 weeks after completion of alternate-day steroid therapy in children with NS. Clinical features of steroid toxicity may serve as useful predictors of AI.