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Iatrogenic adrenal suppression — RACP Paediatrics MCQ

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ModerateEndocrineIatrogenic adrenal suppressionRACP Paediatrics

A 6-year-old who has been on high-dose inhaled corticosteroids for severe asthma for 2 years develops fatigue and recurrent hypoglycaemia during a viral illness. Morning cortisol is low and ACTH is low. There is no hyperpigmentation. What is the most likely cause?

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Correct answer: D — Iatrogenic adrenal suppression

Low cortisol with low ACTH (secondary adrenal insufficiency) without hyperpigmentation in a child on high-dose inhaled corticosteroids indicates iatrogenic HPA axis suppression. Even inhaled and topical corticosteroids can suppress the HPA axis, particularly at high doses. Stress-dose hydrocortisone is needed during illness. Gradual weaning and adrenal axis testing are required.

Reference: RCH Melbourne – 2023 – Adrenal Insufficiency CPG; RACP Paediatric Curriculum – Endocrine