Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia
Heba Al-Rayess,
Amit Lahoti,
Leslie Long Simpson,
Elise Palzer,
Paul Thornton,
Ryan Heksch,
Manmohan Kamboj,
Takara Stanley,
Molly O. Regelmann,
Anshu Gupta,
Vandana Raman,
Shilpa Mehta,
Mitchell E. Geffner,
Kyriakie Sarafoglou
Affiliations
Heba Al-Rayess
Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA
Amit Lahoti
Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA
Leslie Long Simpson
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
Elise Palzer
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
Paul Thornton
Division of Endocrinology and Diabetes, Cook Children’s Medical Center, Fort Worth, TX 76104, USA
Ryan Heksch
Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USA
Manmohan Kamboj
Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA
Takara Stanley
Pediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
Molly O. Regelmann
Division of Pediatric Endocrinology and Diabetes, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA
Anshu Gupta
Division of Pediatric Endocrinology, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA
Vandana Raman
Department of Pediatrics, Division of Pediatric Endocrinology, University of Utah, Salt Lake City, UT 84112, USA
Shilpa Mehta
Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York Medical College, Valhalla, NY 10595, USA
Mitchell E. Geffner
The Saban Research Institute, Children’s Hospital Los Angeles, The Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
Kyriakie Sarafoglou
Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA
A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children <10 years of age with congenital adrenal hyperplasia (CAH). Our workgroup administered a 32-question online survey to PES members. There were 187 respondents (88.9% attending physicians), mostly from university-affiliated clinics (~80%). Ninety-eight percent of respondents prescribed the short-acting glucocorticoid hydrocortisone to treat young children, as per the Endocrine Society CAH Guidelines, although respondents also prescribed long-acting glucocorticoids such as prednisolone suspension (12%), prednisone tablets (9%), and prednisone suspension (6%). Ninety-seven percent of respondents indicated that they were likely/very likely to prescribe hydrocortisone in a thrice-daily regimen, as per CAH Guidelines, although 19% were also likely to follow a twice-daily regimen. To achieve smaller doses, using a pill-cutter was the most frequent method recommended by providers to manipulate tablets (87.2%), followed by dissolving tablets in water (25.7%) to create a daily batch (43.7%) and/or dissolving a tablet for each dose (64.6%). Thirty-one percent of providers use pharmacy-compounded hydrocortisone suspension to achieve doses of <2.5 mg. Our survey shows that practices among providers in the dosing of young children with CAH vary greatly and sometimes fall outside of the CAH Guidelines—specifically when attempting to deliver lower, age-appropriate hydrocortisone doses.
