Introduction

Prolonged corticosteroid therapy is a common paediatric intervention but is associated with serious complications, most notably adrenal insufficiency (AI). This study aimed to identify the risk factors for AI in children receiving long-term corticosteroid treatment.

Material and methods

We conducted a one-year prospective study of children receiving prolonged oral or inhaled corticosteroid (ICS) therapy at supra-physiological doses. Differences between subgroups were analysed using Student’s t-tests for continuous data and chi-square tests for categorical variables.

Results

The study included 71 patients, divided into two groups based on the presence (G1) or absence (G2) of AI. A significant age difference was observed between the two groups (p = 0.027), identifying prolonged exposure as a clinical risk factor for the development of AI. While the overall duration of treatment was significantly longer in the AI group (p = 0.002), sub-analysis by administration route revealed that prolonged duration of ICS therapy was significantly associated with AI (p = 0.012), whereas treatment duration for oral corticosteroids did not reach statistical significance. These findings are consistent with a possible protective effect of the systematic tapering of oral corticosteroids following prolonged use, rather than a true difference in inherent risk between routes. Given the limited statistical power in the oral subgroup (n = 27, p = 0.09), this interpretation should be regarded as a hypothesis requiring confirmation in larger powered sample.

Conclusions

Secondary AI is a significant, underdiagnosed risk in children, closely linked to cumulative corticosteroid exposure and treatment duration. We hypothesise that the lack of systematic tapering, rather than the administration route itself, drives this risk.