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Chrisp GL, Maguire AM, Quartararo M, Falhammar H, King BR, Munns CF, Torpy DJ, Hameed S, Rushworth RL. Variations in the management of acute illness in children with congenital adrenal hyperplasia: An audit of three paediatric hospitals. Clin Endocrinol (Oxf) 2018; 89:577-585. [PMID: 30086199 DOI: 10.1111/cen.13826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Episodes of acute adrenal insufficiency (AI)/adrenal crises (AC) are a serious consequence of congenital adrenal hyperplasia (CAH). This study aimed to assess morbidity from acute illness in CAH and identify factors associated with use of IV hydrocortisone, admission and diagnosis of an AC. METHOD An audit of acute illness presentations among children with CAH to paediatric hospitals in New South Wales, Australia, between 2000 and 2015. RESULTS There were 321 acute presentations among 75 children with CAH. Two-thirds (66.7%, n = 214) of these resulted in admission and 49.2% (n = 158) of the patients received intravenous (IV) hydrocortisone. An AC was diagnosed in (9.0%). Prior to presentation, 64.2% (n = 206) had used oral stress dosing and 22.1% (n = 71) had been given intramuscular (IM) hydrocortisone. Vomiting was recorded in 61.1% (n = 196), 32.7% (n = 64) of whom had used IM hydrocortisone. Admission, AC diagnosis and use of stress dosing varied significantly between hospitals. IM use varied from 7.0% in one metropolitan hospital to 45.8% in the regional hospital. Children aged up to 12 months had the lowest levels of stress dosing and IV hydrocortisone administration. Higher numbers of prior hospital attendances for acute illness were associated with increased use of IM hydrocortisone. CONCLUSION Prehospital and in-hospital management of children with CAH can vary between health services. Children under 12 months have lower levels of stress dosing prior to hospital than other age groups. Experience with acute episodes improves self-management of CAH in the context of acute illness in educated patient populations.
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Affiliation(s)
- Georgina L Chrisp
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Ann M Maguire
- The Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Quartararo
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research and Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Bruce R King
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Craig F Munns
- The Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Shihab Hameed
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - R Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
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Rushworth RL, Falhammar H, Munns CF, Maguire AM, Torpy DJ. Hospital Admission Patterns in Children with CAH: Admission Rates and Adrenal Crises Decline with Age. Int J Endocrinol 2016; 2016:5748264. [PMID: 26880914 PMCID: PMC4736605 DOI: 10.1155/2016/5748264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. To examine patterns of hospitalisation for acute medical conditions in children with congenital adrenal hyperplasia (CAH). Design. A retrospective study of hospitalisation using administrative data. Setting. All hospitals in NSW, Australia. Patients. All patients admitted with CAH and a random sample of admissions in patients aged 0 to 18 years without adrenal insufficiency (AI). Main Outcome Measures. Admissions and comorbidities by age and sex. Results. Of 573 admissions for medical problems in CAH children, 286 (49.9%) were in males, and 236 (41.2%) had a principal diagnosis of CAH or had an adrenal crisis (AC). 37 (6.5%) ACs were recorded. An infection was found in 43.5% (n = 249) of the CAH patient admissions and 51.7% (n = 1613) of the non-AI group, p < 0.001. Children aged up to one year had the highest number of admissions (n = 149) and six ACs (four in males). There were 21 ACs recorded for children aged 1-5 years. Older CAH children had fewer admissions and fewer ACs. No in-hospital deaths were recorded. Conclusions. Admission for medical problems in CAH children declines with age. An AC was recorded in 6.5% of the admissions, with the majority of ACs occurring in the 1 to 5 years age group and there were no deaths.
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Affiliation(s)
- R. Louise Rushworth
- School of Medicine, Sydney, The University of Notre Dame, Australia, 160 Oxford Street, Darlinghurst, NSW 2010, Australia
- *R. Louise Rushworth:
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Menzies School of Health Research and Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, NT 0810, Australia
| | - Craig F. Munns
- Endocrinology and Diabetes, The Children's Hospital Westmead, Hawkesbury Road, Westmead, NSW 2145, Australia
- Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ann M. Maguire
- Endocrinology and Diabetes, The Children's Hospital Westmead, Hawkesbury Road, Westmead, NSW 2145, Australia
| | - David J. Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
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