Corticosteroid therapy and adverse effects

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Target exams

Red flags

• A child on long-term or high-dose corticosteroids who collapses, vomits, or becomes hypoglycaemic during a febrile illness is in adrenal crisis until proven otherwise
• Abrupt cessation of systemic corticosteroids after more than two to three weeks of pharmacologic dosing without a weaning plan
• Failure to give stress-dose hydrocortisone before surgery, sepsis, or major trauma in a child with known or suspected adrenal suppression
• Inhaled corticosteroid escalated to a very high dose (especially fluticasone) without checking for declining growth, weight, or cortisol
• Interpreting a single random cortisol as reassuring during critical illness, when the axis is dynamically stressed
• Using dexamethasone where mineralocorticoid activity is needed, or hydrocortisone where profound anti-inflammatory potency is needed, without understanding potency equivalence

Life stages

Care settings

Clinical exam formats

Board mappings

• General and Community Paediatrics
• Current 2026 PREP curriculum — Learning Objective: Safe prescribing and medication management in infants, children and young people
• Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
• Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
• Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Quality and safety, including medication safety
• Clinical Applications
• Medical Sciences
• Long Cases
• Short Cases
• 4. Professional skills and knowledge: Patient management
• 7. Patient safety, including safe prescribing
• 8. Quality improvement and patient safety
• General Paediatrics: Prescribes and monitors medicines safely, including corticosteroids and adrenal replacement therapy
• Foundation of Practice (FOP)
• Theory and Science (TAS)
• Applied Knowledge in Practice (AKP)
• Clinical
• History
• Communication
• General Pediatrics Content Outline — Domain 10: Principles of Pharmacology and Medication Management
• General Pediatrics Content Outline — Domain 4: Endocrine Disorders
• General Pediatrics Content Outline — Universal Task 4: Management and Treatment
• Systems-Based Practice 2: Medication Safety and Stewardship
• Patient Safety/Quality Improvement 1: Medication Safety
• Medical Knowledge 2: Diagnostic and Therapeutic Decision Making
• Medical Expert
• Pharmacist
• Pediatrics: Core EPA #5 — Recommending and Initiating Pharmacologic Interventions