To the Editor: The recent article by Jung and Inder1 provides sensible advice for the safe management of adults with adrenal insufficiency (AI) during illness and surgery, without risking adrenal crisis or excessive steroid dosing. However, the authors make no reference to paediatric practice and no guidelines have been provided for the body-size-related steroid doses required in paediatric patients with AI, either for routine steroid replacement or during illness and surgery. It is important that doctors be aware that the doses recommended by Jung and Inder are not suitable for children with AI.
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- 1 Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW.
- 2 Australasian Paediatric Endocrine Group.
- 1. Jung C, Inder WJ. Management of adrenal insufficiency during the stress of medical illness and surgery. Med J Aust 2008; 188: 409-413. <MJA full text>
- 2. Maguire AM, Ambler GR, Moore B, et al. Prolonged hypocortisolemia in hydrocortisone replacement regimens in adrenocorticotrophic hormone deficiency. Pediatrics 2007; 120: e164-e171.
- 3. Joint LWPES/ESPE CAH Working Group. Consensus statement on 21-hydroxylase deficiency from the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology. J Clin Endocrinol Metab 2002; 87: 4048-4053.
- 4. Australasian Paediatric Endocrine Group. Hormones and me: management of emergency or “stress” situations where hypoglycaemia or cortisol deficiency occur. Sydney: Serono Symposia Australasia, 2000.