Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia
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 P...
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| Format: | Article |
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MDPI AG
2023-11-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/12/1871 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Heba Al-Rayess |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T20:53:24Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-08T20:53:24Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-17a03bf7c1cb49a689e2c2da95696c842023-12-22T14:00:20ZengMDPI AGChildren2227-90672023-11-011012187110.3390/children10121871Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal HyperplasiaHeba Al-Rayess0Amit Lahoti1Leslie Long Simpson2Elise Palzer3Paul Thornton4Ryan Heksch5Manmohan Kamboj6Takara Stanley7Molly O. Regelmann8Anshu Gupta9Vandana Raman10Shilpa Mehta11Mitchell E. Geffner12Kyriakie Sarafoglou13Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USADepartment of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USADivision of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USADivision of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USADivision of Endocrinology and Diabetes, Cook Children’s Medical Center, Fort Worth, TX 76104, USACenter for Diabetes and Endocrinology, Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USADepartment of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USAPediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USADivision of Pediatric Endocrinology and Diabetes, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USADivision of Pediatric Endocrinology, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USADepartment of Pediatrics, Division of Pediatric Endocrinology, University of Utah, Salt Lake City, UT 84112, USADepartment of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York Medical College, Valhalla, NY 10595, USAThe Saban Research Institute, Children’s Hospital Los Angeles, The Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USADepartment of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USAA 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.https://www.mdpi.com/2227-9067/10/12/1871congenital adrenal hyperplasiaglucocorticoidspediatricsformulationshydrocortisone |
| spellingShingle | 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 Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia Children congenital adrenal hyperplasia glucocorticoids pediatrics formulations hydrocortisone |
| title | Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia |
| title_full | Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia |
| title_fullStr | Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia |
| title_full_unstemmed | Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia |
| title_short | Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia |
| title_sort | practice variation among pediatric endocrinologists in the dosing of glucocorticoids in young children with congenital adrenal hyperplasia |
| topic | congenital adrenal hyperplasia glucocorticoids pediatrics formulations hydrocortisone |
| url | https://www.mdpi.com/2227-9067/10/12/1871 |
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