Abstract
<jats:p>Background: Adrenal suppression is a potential side effect of glucocorticoid (GC) therapy. Timely diagnosis and management can significantly reduce morbidity and mortality from adrenal crisis. There is a need for pediatric-specific guidelines to provide non-endocrinologist GC prescribers with diagnostic and management tools to keep children and youth safe. Objectives: To assess the adrenal suppression screening and management practices amongst surveyed pediatric endocrinology members of the Pediatric Endocrinology Society (PES), to support the need for national pediatric adrenal suppression guidelines. Methods: A survey (19 questions, implied consent model), developed by members of the PES Adrenal Special Interest Group and the PES Drugs and Therapeutics Committee, was distributed to PES members. Results: Among 154 survey respondents, 90.9% were pediatric endocrinology attendings, predominantly working in the US (91.6%) in an academic setting (86.4%). A majority (70.1%) have seen adrenal crisis due to adrenal suppression. Only 48.1% participants follow any pediatric adrenal suppression guidelines (within which 32.5% used a local guideline); 27.9% use adult guidelines. While 52.6% reported that adrenal suppression cases are managed by both endocrinologists and non-endocrinologists, only 38.3% of respondents provide resources to non-endocrinologists. Most screen for adrenal suppression with early morning cortisol (88.3%) or a low-dose ACTH stimulation test (55.8%). Notably, 8.4% of respondents believe that use of inhaled corticosteroids is not associated with a risk of adrenal suppression. Nearly all respondents (99.4%) agree that an official PES guideline on adrenal suppression would reduce morbidity and mortality by raising awareness and standardizing management. Conclusion: Adrenal crisis due to adrenal suppression remains a preventable yet persistent threat. Screening and management practices vary widely among North American pediatric endocrinologists, underscoring the need for pediatric-specific guidelines. Establishing such guidelines would fill a critical care gap and promote a standardized approach to diagnosis and management across clinicians.</jats:p>