Single serum cortisol values at 09:00 h can be indices of adrenocortical function in children with Kawasaki disease treated with intravenous immunoglobulin plus prednisolone

Combination treatment with intravenous immunoglobulin (IVIG) plus prednisolone iseffective for prevention of cardiovascular complications in children with Kawasaki disease(KD). However, administration of prednisolone for approximately 20 d in this regimencauses adrenocortical suppression in a high proportion of treated children. To establish asimple method to screen for this suppression, we performed a prospective study on 72children with KD treated with this regimen in our institution from February 2012 to March2014. By performing ROC analysis of 21 initial patients treated between February and June2012, a serum cortisol value at 09:00 h of 5 mcg/dL was established as a threshold forintact adrenocortical function, which is equivalent to a peak serum cortisol value ofhigher than 15 mcg/dL in the CRH stimulation test. Then, we applied this screening test to51 subsequent patients treated between July 2012 and March 2014. Approximately 90% of thepatients with morning serum cortisol values above 5 mcg/dL 2 to 6 mo after the cessationof initial prednisolone treatment had peak serum cortisol values exceeding 15 mcg/dL,suggesting the efficacy of this approach.