Adrenalna insuficijencija i stres – kako postupiti s djetetom na kroničnoj glukokortikoidnoj terapiji

Adrenal insufficiency is a frequently underestimated disorder that, if unrecognized, increases the risk of adverse outcomes during acute illnesses and diagnostic or therapeutic interventions. The rising incidence of chronic diseases commonly treated with glucocorticoids has made iatrogenic adrenal insufficiency a significant concern even within the pediatric population.The aim of this paper is to emphasize the importance of acknowledging and promptly recognizing signs of adrenal insufficiency in children, both in those receiving chronic hydrocortisone replacement therapy for previously diagnosed adrenal insufficiency and in those on long-term glucocorticoid therapy in whom adrenal insufficiency may remain undetected. Through a systematic review and analysis of relevant scientific literature, clinical guidelines, and textbooks, we provide an overview of the pathophysiology underlying adrenal insufficiency, its recognition, and management, with special emphasis on adrenal insufficiency induced by chronic glucocorticoid therapy. By synthesizing available recommendations and guidelines, we outline strategies for identifying risk factors for adrenal insufficiency, offer management recommendations for acute illness and stress, and propose guidance for the safe tapering and discontinuation of chronic glucocorticoid therapy.Raising awareness of iatrogenic adrenal insufficiency in children treated with long-term glucocorticoids, recognizing that these patients are unable to mount an adequate stress response, and educating physicians and caregivers on timely action in emergencies are fundamental steps toward reducing the risk of severe complications.