Bijnierschorsinsufficiëntie door glucocorticoïdgebruik in de oncologie op de kinderleeftijd

Treatment with supraphysiologic doses glucorticoids is the most common cause of secondary adrenal insufficiency. Recognition of the atypical clinical signs of adrenal insufficiency may be difficult. We present four children with a malignancy; two boys aged 2 and 12 years and two girls aged 5 and 15 years, with diverse clinical presentations of glucocorticoid-induced adrenal insufficiency. Adrenal insufficiency resulting in inadequate cortisol levels during periods of stress (e.g. illness, trauma, surgery), may lead to life-threatening hypoglycemia and/or hypotension. The diagnostic work-up includes a low dose ACTH test. Glucocorticoid coverage (hydrocortisone) during periods of stress is recommended in order to prevent life-threatening situations. Due to the lack of evidence-based guidelines, there is no agreement on the optimal treatment of adrenal insufficiency. Therefore, we propose a flowchart for the indication of glucocorticoid coverage.