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Introduction: Chronic glucocorticoid therapy by systemic and inhaled forms is the most common cause of adrenal insufficiency. There is no administrative form, dosing, duration or underlying disease for which it is more common, although higher dose and prolonged use have highest risk. Clinical case characteristics: A 11-year-old girl was brought with cough and cold for a week, fever, vomiting and headache for one day. She had been diagnosed to have asthma and allergic rhinitis 7 years ago. She was started on Mometasone 120mcg nasal spray OD, used for 4 years and Budesonide 64mcg nasal spray BD for 1 year. She was also put on Formoterol 6mcg + Mometasone 200mcg MDI, used for 4 years, and Formoterol 6mcg + Budesonide 200mcg MDI, used for 1 year. No significant birth or family history. On examination, child was severely stunted and wasted, with height and weight below - 3 standard deviations on IAP growth chart. She was hemodynamically stable, head to toe and systemic examination was normal. Outcome: She was found to have severe hyponatremia, which was corrected. Due to significant past history of chronic usage of intranasal and inhaled corticosteroids, adrenal insufficiency was suspected and serum cortisol levels done, which were low. ACTH stimulation test was administered and serum cortisol levels tested at 30 minutes and 60 minutes, remained below the reference range after the test. Hence the child was diagnosed to have adrenal insufficiency. Pediatric endocrinology reference taken and steroids tapered over several weeks. Serum cortisol levels monitored during follow up were normal. Conclusion: Clinicians must have a high index of suspicion, especially in patients with nonspecific symptoms after cessation of high-dose or long-term steroids and consider testing for cortisol levels. Patient education, monitoring and regular follow up is a key feature of management of this condition. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is a serious concern for young children because it can result in impaired cognitive performance, behavioural and motor development, coordination, language development, and scholastic achievement, as well as increased morbidity from infectious diseases. While severe anaemia is typically addressed with urgency, mild-to-moderate anaemia is sometimes overlooked. However, even mild cases can have a significant impact on a child's health and development. Thus, oral iron supplementation, by reducing anaemia, can contribute to the development of a healthier and more productive population. Aim: To assess the effect of daily Iron Folic Acid (IFA) supplementation among 36-59 month old children with mild-to-moderate anaemia. Materials and Methods: This quasi-experimental study was conducted in the rural field practice areas of a tertiary care teaching hospital in central Karnataka, India from March 2022 to February 2023. After baseline assessment, 53 children aged between 36-59 months old in Anganwadi centres of the study area with mild-to-moderate anaemia (Haemoglobin - Hb: 10.9 -- 7 g/dL) were recruited for the study after obtaining informed written consent from the parents. The IFA supplementation was administered under supervision for six months. The primary outcome was rise in the Hb concentration. The paired t-test was used to statistically analyse the data. Results: Among the 53 study participants, the majority (27, 51%) were boys, and the mean age of the study participants was 46.6±8.4 months. The study showed that after six months of iron supplementation among 36-59 month old children with mild-to-moderate anaemia, there was a rise in the mean {Standard Deviation (±SD)} Hb by 0.71±0.32 gm/dL in the study participants, and it was found to be statistically significant (2.579, p=0.011). The increase in Hb was found in both girls (0.84±0.41 gm/dL) and boys (0.83±0.39 gm/dL). Conclusion: The study concluded that supervised intervention for mild-to-moderate anaemia in preschool children has the potential to reduce the prevalence of iron deficiency anaemia among this vulnerable population, but it requires a joint effort from all stakeholders involved. [ABSTRACT FROM AUTHOR]