{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:18:58Z","timestamp":1777853938207,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Glucocorticoids are commonly used in pediatric critical illness and may lead to subsequent adrenal insufficiency, causing morbidity among pediatric intensive care unit (PICU) survivors. We aimed to determine the prevalence of and risk factors for adrenal insufficiency among children who received glucocorticoids during PICU admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using structured medical record review to determine the prevalence of adrenal insufficiency and clinical characteristics of PICU patients 0\u201318 years old who received enteral and\/or parenteral glucocorticoids. Patients were consecutively admitted to an academic tertiary referral PICU over 2 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 530 patients who received glucocorticoids, 12 (2.3%) were diagnosed with adrenal insufficiency at a median of 55 (IQR 8-156) days after initial glucocorticoid exposure. Unadjusted analyses showed that patients with adrenal insufficiency were younger (median 0.5 vs 2 years,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.020), had a longer PICU stay (79 vs 4 days,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001) and hospital stay (96 vs 6 days,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001), and had a lower survival rate at 1 year after PICU discharge (75% vs 94%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.033). There were no significant differences in sex, race\/ethnicity, illness severity, or diagnostic categories. Patients with adrenal insufficiency were more likely to have received glucocorticoids for hyperinflammation (21% vs 8%) and less likely for reactive airway disease (10% vs 26%) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.036), had a higher median total hydrocortisone equivalent dose (2508 vs 480\u2005mg,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.007), and were more likely to have had a steroid taper (48% vs 24%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.003). Multivariable logistic regression showed no significant associations between clinical characteristics and the diagnosis of adrenal insufficiency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among PICU patients who received glucocorticoids, 2.3% were subsequently diagnosed with adrenal insufficiency. We identified potential risk factors for adrenal insufficiency after glucocorticoid use in the PICU, which warrant future study to better delineate and mitigate adrenal insufficiency's contribution to morbidity and mortality among critically ill children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666251352447","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T04:18:53Z","timestamp":1750911533000},"page":"1285-1291","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5366-8317","authenticated-orcid":false,"given":"Ashley N.","family":"Radig","sequence":"first","affiliation":[{"name":"Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa A.","family":"Curtis","sequence":"additional","affiliation":[{"name":"Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Westlund","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina L.","family":"Cifra","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1530\/EC-19-0318"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4919-5"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.4266\/acc.2024.00647"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-024-01616-x"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199910000-00032"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.80.1.51"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.110.3.563"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00130478-200204000-00004"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000159854.23324.84"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2019-000569"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.05.014"},{"issue":"11","key":"e_1_3_2_13_2","first-page":"1","article-title":"Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukemia","volume":"11","author":"Rensen N","year":"2017","unstructured":"Rensen N, Gemke RJBJ, van Dalen EC, et al. Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukemia. Cochrane Database Syst Rev. 2017;11(11):1\u201044. doi: https:\/\/doi.org\/10.1002\/14651858.CD008727.pub4","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4914-x"},{"issue":"4","key":"e_1_3_2_15_2","first-page":"466","article-title":"Evaluation of the hypothalamic-pituitary-adrenal axis in a paediatric intensive care unit","volume":"15","author":"Demiral M","year":"2019","unstructured":"Demiral M, Kiral EY, Dinleyici EC, et al. Evaluation of the hypothalamic-pituitary-adrenal axis in a paediatric intensive care unit. 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