Abstract

Objective: Aim of this study was to evaluate whether intravenous bolus administration of dexamethasone, a long-acting and potent glucorticoid, and methylprednisolone, a moderately acting and moderately potent glucocorticoid, causes adrenal insufficiency.

Material and Methods: Forthy-six patients (24 girls, 22 boys) aged 2 months-18 years who were treated with intravenous dexamethasone or methylprednisolone for more than ten days for various reasons and referred to the department of pediatric endocrinology for discontinuation of steroids were included. Chronological age, duration of corticosteroid treatment (in days), mean hydrocortisone equivalent treatment dose (mg/m2/day), basal ACTH and cortisol levels, and peak cortisol response at low dose ACTH stimulation test were recorded.Morning serum basal cortisol levels of less than 3 μg/dl (85 nmol/L) were evaluated in favor of adrenal insufficiency due to corticosteroid use, and above 20 μg/dl was considered normal. Peak cortisol level ≥18 μg/dl (500 nmol/L) was considered normal in low-dose ACTH stimulation test.

Results: Mean age of the patients was 7.9±5.8 years (range 2 months-18 years), mean duration of corticosteroid use was 26.2±11.8 days (range 12-75) days, mean daily dose number was 2.2±1.2 (range 1-4), mean hydrocortisone equivalent corticosteroid dose was 235.6±114.6 (range 86-428) mg/m2/day. Mean basal cortisol and ACTH levels were 9.9±4.0 (range 4.2-16.8) μg/dl, 30.4±18.6 (range 8.6-72.5) pg/ml, respectively. Peak cortisol response at low dose ACTH stimulation test was ≥18 μg/dl in all cases.

Conclusion: In this study, intravenous bolus administration of glucocorticoids did not cause adrenal suppression in any case. Despite the intravenous administration of potent glucocorticoids such as dexamethasone and methylprednisolone over a long period of 26 days in supraphysiological doses, adrenal suppression did not develop in any of the cases, indicating that the administration route of the drug is as important as the duration and the dose of treatment. Intravenous bolus administration of glucorticoids may be less risky for adrenal suppression.Further studies involving more cases are needed.

Keywords: Adrenal insufficiency, Dexamethasone, Hypothalamo-hypophyseal system, Methylprednisolone

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1.
Vurallı D, Alikaşifoğlu A. The Effect of Intravenous Bolus Administration of High Doses of Medium and Long-Term Dexamethasone and Methylprednisolone to the Hypothalamus-Pituitary-Adrenal Axis. Turk J Pediatr Dis [Internet]. 2020 Jun. 26 [cited 2025 Aug. 23];14(4):333-8. Available from: https://turkjpediatrdis.org/article/view/678