Adrenal insufficiency during physiological stress in children after kidney or liver transplantation

Efraim Bilavsky*, Adi Dagan, Havatzelet Yarden-Bilavsky, Miriam Davidovits, Rivka Shapiro, Eytan Mor, Naomi Weintrob, Jacob Amir, Yaron Avitzur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The aim of this study was to assess the prevalence and risk factors of AI in pediatric recipients of kidney or liver transplantation admitted because of a physiological stress episode and to identify patients that might be at risk of adrenal crises by clinical and laboratory parameters at admission. Adrenal function was prospectively evaluated by a standard (250 μg) adrenocorticotropin test in 48 recipients. Data on clinical and laboratory parameters were collected. AI was diagnosed in 11 patients: 10/32 (31.3%) children on long-term steroid treatment and 1/16 (6.25%) untreated. The only risk factor for AI was corticosteroids cumulative dose of >0.15 mg/kg/day during the last six months (p = 0.02, OR 6.67; 95% CI: 0.97-45.79). No correlation was found between clinical or laboratory signs of adrenal crisis on admission and the presence of AI. None of the patients with AI who did not receive stress dose (n = 8) developed adrenal crisis. AI is relatively common in children receiving prolonged corticosteroid treatment after kidney or liver transplantation. Clinical parameters on admission could not reliably identify patients with AI. Universal administration of a stress dose during physiological stress might not be required. However, at this point, the only method to identify patients that will benefit from a stress dose is through the ACTH test.

Original languageEnglish
Pages (from-to)314-320
Number of pages7
JournalPediatric Transplantation
Issue number3
StatePublished - May 2011


  • adrenal insufficiency
  • adrenocorticotropic hormone test
  • children
  • kidney transplantation
  • liver transplantation
  • physiological stress


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