Original Articles: 2019 Vol: 11 Issue: 1
The Effect of Glucocorticoid Therapy on Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression in Pediatrics: A Literature Review
Corticosteroids are a class of steroid hormones, a hormone produced by the adrenal gland in response to the adrenocorticotropic hormone (ACTH) released by the pituitary gland. The glucocorticoid (GC) group is a corticosteroid whose main effects on metabolism and anti-inflammatory, whereas its effect on water balance and electrolytes is small or insignificant. GC are standard therapy to reduce inflammation and activation of the immune system in various diseases, this is why these drugs are widely used for various diseases. The side effects of GC involve most major organ systems such as musculoskeletal, gastrointestinal, cardiovascular, endocrine, neuropsychiatric, dermatological, ocular, and immunologic. HPA axis suppression occurs due to endogenous and exogenous glucocorticoids do negative feedback control that is short-loop feedback and long-loop feedback on the HPA axis by suppressing hypothalamic corticotropin-releasing hormone (CRH) production and ACTH secretion. It is characterized by the decrease of ACTH levels with clinical manifestation hypotension, hypoglycemia, weakness/fatigue, nausea, vomiting and can lead to an adrenal crisis. Complication of GC therapy increased, in proportion to dose, type/strengthness GC, duration of therapy and increased frequency of administration. This article attempts to review the effect of glucocorticoid on HPA axis supression in pediatrics based on literature review.