Author(s): Nani Wijayanti D. N, Oki Nugraha Putra, Ana Khusnul Faizah


DOI: 10.52711/0974-360X.2023.00426   

Address: Nani Wijayanti D. N*, Oki Nugraha Putra, Ana Khusnul Faizah
Department of Clinical Pharmacy, Hang Tuah University, 150 Arif Rahman Hakim Street, Surabaya, Indonesia.
*Corresponding Author

Published In:   Volume - 16,      Issue - 6,     Year - 2023

Adrenal suppression is a condition that refers to the deficit or inadequate cortisol production that results from exposure of the HPA axis to exogenous glucocorticoid. Corticosteroid (prednisone) is the backbone therapy for childhood nephrotic syndrome which is a sensitive steroid. According to KDIGO and IDAI, the protocol therapy for nephrotic syndrome is prednisone which given as initial and maintenance therapy. The initial therapy is by giving prednisone 60 mg/m2 for 3 – 4 weeks in divided dose or single dose followed by the alternate day 40 mg/m2 for 4 – 12 weeks. This protocol may suppress endogenous cortisol production by inhibiting the adrenal cortex. The long suppression of the hypothalamic-pituitary-adrenal (HPA) axis has significant impact on its function for several months to years. Even though a study about adrenal suppression in children with nephrotic syndrome was conducted, it was important to assess cortisol levels in children with a high dose and long term prednisone exposure based on its protocol. All studies showed a decrease in cortisol levels in the end of treatment, it lasted for years to return in normal condition. Inability to reach cortisol level in normal range may indicate adrenal suppression. This article will discuss the potential development of adrenal suppression in the patient who treated by prednisone in divided dose by monitoring cortisol level.

Cite this article:
Nani Wijayanti D. N, Oki Nugraha Putra, Ana Khusnul Faizah. Adrenal Suppression after Prednisone Exposure in children with Steroid Sensitive Nephrotic Syndrome: Case Report. Research Journal of Pharmacy and Technology 2023; 16(6):2601-3. doi: 10.52711/0974-360X.2023.00426

Nani Wijayanti D. N, Oki Nugraha Putra, Ana Khusnul Faizah. Adrenal Suppression after Prednisone Exposure in children with Steroid Sensitive Nephrotic Syndrome: Case Report. Research Journal of Pharmacy and Technology 2023; 16(6):2601-3. doi: 10.52711/0974-360X.2023.00426   Available on:

1.    Ahmet A, Kim H, Spier S. Adrenal Suppression : A Practical Guide to The Screening and Management of This Under - recognized Complication of Inhaled Corticosteroid Therapy. AACI Journal 2011: 7 (13): pp. 1 - 12.
2.    Liu D, Ahmet A, Ward L, Krshnamoorthy P, Mandelcom  E, Leigh R, et al. A Practical Guide to The Monitoring and Management of The Complications of Systemic Corticosteroid Therapy. AACI Journal 2013;30 (9):1-25.
3.    Miller WL, Fluck CE. Adrenal Cortex and Its Disorder. In Sperling MA, editor, Pediatric Endocrinology Fourth Edition, Philadelphia: Saunders Elsivier; 2014, p.537-538.
4.    Shulman DL, Palmert MR, Kemp SF. Adrenal Insufficiency : Still a Cause of Morbidity and Death in Childhood. Pediatrics 2007; (119):e484-e494.
5.    Widmaier E, Raff H, Strang K. Vander's Human Physiology The Mechanisms of Body Function Thirteenth Edition . New York: McGraw – Hill; 2014, pp. 319 - 361.
6.    Chrousus G, Pavlaki AN, Magiakou MA. Glucocorticoid Therapy and Adrenal Suppression. Endotext. South Dartmouth (MA): Inc; 2011, pp. 1 - 17.
7.    Furst DF, Saag KG. Glucocorticoid Withdrawal. UpToDate Wolters Kluwer 2015:1-19.
8.    Chou S. Adrenal Insufficiency . NEJM 2012:1 (65):  pp. e97 - e108.
9.    Stewart, PM, Newell-Price JDC. The Adrenal Cortex In: Melmed, S., Polonsky, K.S., Larsen PR., Kronenberg HM. 2016. Williams Text Book of Endocrinology. 13th Eds.Philadelphia: Elsevier; 2016, pp.505–7.
10.    Alatas H, Taralan T, Partini P, Sudung OP. Consensus on Management of Idiopathic Nephrotic Syndrome in Children. Jakarta: Indonesian Pediatric Association 2008:1-18.
11.    Trihono PP, Alatas H, Tambunan T, Pardede SO. Management of Idiopathic Nephrotic Syndrome in Children 2nd Edition. Jakarta: Nephrology Department Indonesian Pediatric Association 2012:1-32.
12.    Niaudet P, Boyer O. Idiopathic nephrotic Syndrome in CHildren: Clinical Aspects. In Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein S, editors,  Pediatric Nephrology Seventh Edition, New York: Springer; 2016, p.841-843.
13.    Krishnan RG. Nephronic Syndrome . Paediatric and Child Health 2009; 22 (8): pp. 337 - 340.
14.    Lombel RM, Gipson DS, Hodson EM. Treatment of Steroid-Sensitive Nephrotic Syndrome: New Guidelines from KDIGO. Pediatr Nephrol 2012:1-17.
15.    Dolan N, Gill D. Management of Nephrotic Syndrome. Paediatrics and Child Health 2008: 18(18): pp. 269-374.
16.    Lennon R., Watson L, JA Webb N. Nephrotic Syndrome in Children. Paediatric and Child Health 2009;20 (1):36 - 42.
17.    Barrett, EJ. The Adrenal Gland. In Medical Physiology, A Cellular and Molecular Approach. Philadelphia: Elsevier Saunders; 2012, pp. 1057-1073.
18.    Nieman, L. Pharmacologic Use of Glucocorticoids. UpToDate Wolters Kluwer 2015: pp. 1 - 14.
19.    Abeyagunawardena AS, Hindamarsh P, Trompeter R. Adrenocortical Suppression Increase The Risk of Relapse in Nephrotic Syndrome . Arch Dis Child 2007; (92):585-588.
20.    Ramachandran R, Jairam A, Bhansali A, Jha V, Gupta K, Sakhuja V, et al. Study of Hypothalamic Pituitary Adrenal Axis in Patients of Membranous Nephropathy Receiving Modified Ponticelli Regimen. Indian J. Nephrol 2015; 1 (25):1-5.
21.    Coursin D, Wood. Corticosteroid Supplementation for Adrenal Insufficiency. JAMA 2002: (287): pp. 236 - 240.
22.    Alexandraki KI, Kaltsas GA, Chrousos GP. Adrenal Suppression. [Updated 2018 Oct 1]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000-. Available from:
23.    Leonie H. A. Broersen, Alberto M. Pereira, Jens Otto L. Jørgensen, Olaf M. Dekkers, Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis, The Journal of Clinical Endocrinology & Metabolism 2015;(100)6: pp. 2171-2180,
24.    Leoni, H.A. Albrto Pereira. Case : Syndrome in children with nephrotic syndrome.
25.    Gupta P, Bhatia V. Corticosteroid Physiology and Principles of Therapy. Indian J Pediatr 2008; 75: 1039-44. 10.1007/s12098-008-0208-1.
26.    Abu Bakar K, Khalil K, Lim YN, Yap YC, Appadurai M, Sidhu S, Lai CS, Anuar Zaini A, Samingan N, Jalaludin MY. Adrenal Insufficiency in Children with Nephrotic Syndrome on Corticosteroid Treatment. Front pediatr 2020; 15:164. doi: 10.3389/fped.2020.00164.
27.    Mantan M, Grover R, Kaushik S, Yadav S. Adrenocortical Suppression in Children with Nephrotic Syndrome treated with Low-dose Alternate Day Corticosteroid. Indian J Nephrol 2018; 28(3): 203-2008. DOI: 10.4103/ijn.IJN_80_17

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