Adrenal Suppression after Prednisone Exposure in children with Steroid Sensitive Nephrotic Syndrome: Case Report

Abstract

Adrenal suppression is a condition that refers to the deficit or inadequate cortisol production that results from exposure of the HPA axis to exogenous glucocorticoid. Corticosteroid (prednisone) is the backbone therapy for childhood nephrotic syndrome which is a sensitive steroid. According to KDIGO and IDAI, the protocol therapy for nephrotic syndrome is prednisone which given as initial and maintenance therapy. The initial therapy is by giving prednisone 60 mg/m2 for 3 – 4 weeks in divided dose or single dose followed by the alternate day 40 mg/m2 for 4 – 12 weeks. This protocol may suppress endogenous cortisol production by inhibiting the adrenal cortex. The long suppression of the hypothalamic-pituitary-adrenal (HPA) axis has significant impact on its function for several months to years. Even though a study about adrenal suppression in children with nephrotic syndrome was conducted, it was important to assess cortisol levels in children with a high dose and long term prednisone exposure based on its protocol. All studies showed a decrease in cortisol levels in the end of treatment, it lasted for years to return in normal condition. Inability to reach cortisol level in normal range may indicate adrenal suppression. This article will discuss the potential development of adrenal suppression in the patient who treated by prednisone in divided dose by monitoring cortisol level.