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Glucocorticoid adrenal suppression — MRCPCH TAS MCQ

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ModeratePharmacologyGlucocorticoid adrenal suppressionMRCPCH TAS

A child with nephrotic syndrome has received repeated high-dose prednisolone courses. During gastroenteritis he becomes hypotensive with hyponatraemia and hypoglycaemia. What is the most likely mechanism?

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Correct answer: A — Suppression of the hypothalamic-pituitary-adrenal axis

Repeated systemic glucocorticoids can suppress the hypothalamic-pituitary-adrenal axis, causing adrenal insufficiency during physiological stress. Loop diuretics can disturb electrolytes but would not explain steroid-associated stress failure. The pearl is that children on prolonged steroids may require sick-day steroid planning.

Reference: BNFc; Nelson Textbook of Pediatrics; RCPCH Theory examination syllabi