Overview
New evidence from a single-center retrospective study suggests that children treated with supraphysiological glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis (JIA) can be safely weaned off steroids with a remarkably low risk of adrenal crisis. The findings support careful tapering, early transition to alternate-day dosing where appropriate, and rapid access to specialist guidance for families navigating therapy during illness or stress.
Study Design and Population
The study was conducted at a tertiary pediatric hospital and followed children aged one month to under 16 years who received high-dose glucocorticoids for nephrotic syndrome or JIA. Researchers tracked 2,363 patient months of therapy, recording monthly treatment regimens alongside emergency department visits, electrolyte changes, clinical codes, and team reports that could signal an adrenal crisis.
Adrenal Crisis Incidence During Weaning
After glucocorticoids were discontinued, there were 974 patient months of observation without a single adrenal crisis event. During the tapering phase, most patients with nephrotic syndrome and a subset with JIA transitioned to an alternate-day dosing regimen after a brief period of daily supraphysiological therapy. When compared to published cohorts, the very low incidence of adrenal crises could not be explained by sample size alone, pointing to the effectiveness of deliberate taper protocols.
Key Tapering Elements
The study highlights several practical elements that may drive safer weaning in children:
– Structured taper plans with clear milestones
– Early adoption of alternate-day regimens after initial daily dosing when disease control permits
– Systematic surveillance of potential adrenal suppression during the taper
– Strong integration of family support and rapid access to clinician advice during health crises or intercurrent illnesses
Implications for Clinical Practice
The findings imply that, in the right pediatric setting, high-dose glucocorticoids used for several weeks can be tapered and stopped without routine biochemical testing, provided there is a robust specialist pathway and access to expert guidance for families. The study emphasizes avoiding unnecessary testing in straightforward cases while maintaining vigilance for signs of adrenal insufficiency during febrile illness, surgery, or significant stress.
Practical Guidance for U.S. Practice
To translate these results into everyday care, pediatric services should:
– Implement structured taper protocols with explicit patient- and family-facing instructions
– Create expedited channels for clinician advice and escalation in suspected crisis scenarios
Discharge materials should standardize language about stress dosing during illness and outline clear steps for seeking urgent care if symptoms of adrenal insufficiency arise. Routine biochemical testing may be reserved for complex cases or prolonged therapy, while prioritizing education on self-monitoring and recognition of crisis symptoms.
Why Alternate-Day Dosing Helps
Switching to an alternate-day regimen after an initial period of daily high-dose exposure appears to reduce ongoing adrenal suppression without compromising disease control. This approach can be particularly beneficial for chronic conditions like nephrotic syndrome and JIA, where long-term steroid exposure is a concern. Families benefit from a predictable taper timeline and a plan for handling intercurrent illness with appropriate stress dosing.
Conclusion
The observed low incidence of adrenal crisis during and after glucocorticoid taper in this pediatric cohort provides encouraging evidence for a structured, family-centered, and escalation-ready approach to steroid weaning. When guided by specialist pathways and accompanied by rapid access to professional support, tapering can be safely achieved in many children, reducing the risk of life-threatening adrenal suppression while preserving control of nephrotic syndrome or juvenile idiopathic arthritis.
Reference: Finnie J et al. Incidence of adrenal crisis in children and young people receiving high dose glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis. Arch Dis Child. 2025; doi: 10.1136/archdischild-2025-328917.
