{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:51:26Z","timestamp":1747183886969,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T00:00:00Z","timestamp":1591056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Adrenal crises (AC) are acute episodes of adrenal insufficiency (AI). Manifestations include hypotension and electrolyte disturbances. Glucocorticoid stress dosing (SD) can prevent AC progression, but its effect on physiological parameters has not been assessed in a \u2018real world setting\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To assess the effect of prior self\u2010managed glucocorticoid dose escalation on physiological markers in children with congenital adrenal hyperplasia (CAH) presenting to hospital for an acute illness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An audit of records of all children with CAH presenting to paediatric referral hospital between 2000 and 2015. Potassium, sodium and glucose levels, and hypotension were compared between children who had and had not used SD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 321 attendances by patients with CAH and an acute illness during the study period. Any form of SD was used by 64.2% (n\u00a0=\u00a0206); intramuscular (IM) hydrocortisone was used by 22.1% (n\u00a0=\u00a071) and oral only by 41.7% (n\u00a0=\u00a0134). Use of SD (oral and\/or IM) was associated with a significantly lower mean potassium level (4.02\u00a0\u00b1\u00a00.71 vs. 4.27\u00a0\u00b1\u00a00.79\u00a0mmol\/l, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05). Linear regression analysis showed that age (beta: \u22120.04\u00a0years (95% CI \u22120.06, \u22120.02)), diarrhoea (beta: \u22120.41 (95% CI \u22120.06, \u22120.02)) and any form of stress dosing (oral, IM or both) (beta: \u22120.29 (95% CI \u22120.55, \u22120.04)) were each independently and significantly associated with potassium levels. SD was not significantly associated with sodium or glucose concentrations or with estimates of hypotension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patient\u2010initiated SD resulted in a significant reduction in hyperkalaemia and lowered mean potassium levels in paediatric patients with CAH but did not alter significantly sodium and glucose concentrations or incidences of hypotension.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14196","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T06:19:43Z","timestamp":1587104383000},"page":"97-103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The effect of patient\u2010managed stress dosing on electrolytes and blood pressure in acute illness in children with adrenal insufficiency"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0844-520X","authenticated-orcid":false,"given":"Georgina L","family":"Chrisp","sequence":"first","affiliation":[{"name":"School of Medicine Sydney The University of Notre Dame Darlinghurst NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J","family":"Torpy","sequence":"additional","affiliation":[{"name":"Endocrine and Metabolic Unit Royal Adelaide Hospital and University of Adelaide Adelaide SA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann M","family":"Maguire","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital Westmead NSW Australia"},{"name":"Medical School The University of Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Quartararo","sequence":"additional","affiliation":[{"name":"School of Medicine Sydney The University of Notre Dame Darlinghurst NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-6987","authenticated-orcid":false,"given":"Henrik","family":"Falhammar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Diabetes Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden"},{"name":"Menzies School of Health Research and Royal Darwin Hospital Tiwi NT Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce R","family":"King","sequence":"additional","affiliation":[{"name":"John Hunter Children\u2019s Hospital Newcastle NSW Australia"},{"name":"University of Newcastle Newcastle NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig F","family":"Munns","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital Westmead NSW Australia"},{"name":"Medical School The University of Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shihab","family":"Hameed","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital Westmead NSW Australia"},{"name":"Sydney Children\u2019s Hospital Randwick NSW Australia"},{"name":"School of Women\u2019s and Children\u2019s Health University of New South Wales Kensington NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6270-747X","authenticated-orcid":false,"given":"R Louise","family":"Rushworth","sequence":"additional","affiliation":[{"name":"School of Medicine Sydney The University of Notre Dame Darlinghurst NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"issue":"2","key":"e_1_2_7_2_1","first-page":"75","article-title":"The clinical and bio\u2010 chemical spectrum of congenital adrenal 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