# Enda Avoid Long Acting Glucocorticoids Children

> Suggests avoiding synthetic, long-acting glucocorticoids (e.g., prednisolone, dexamethasone) in children with primary adrenal insufficiency (PAI). Use when selecting glucocorticoid replacement for a child with PAI to prevent Cushingoid side effects and dose titration difficulties.

- Skill: `dromlakhani/enda-avoid-long-acting-glucocorticoids-children` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/enda-avoid-long-acting-glucocorticoids-children`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/enda-avoid-long-acting-glucocorticoids-children/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/enda-avoid-long-acting-glucocorticoids-children

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# Avoid Synthetic, Long-Acting Glucocorticoids in Children with PAI

## STEP 1 — Gather Information
Confirm diagnosis of PAI in the child (via ACTH stimulation test or clinical/lab criteria) and assess need for glucocorticoid replacement therapy.

## STEP 2 — Rule In / Rule Out
If the child has PAI and requires glucocorticoid replacement, rule out synthetic, long-acting glucocorticoids (prednisolone, dexamethasone) due to risks in pediatric PAI.

## STEP 3 — Classify or Stratify
Classify glucocorticoid options: preferred short-acting agents (hydrocortisone, cortisone acetate) versus avoided long-acting agents (prednisolone, dexamethasone).

## STEP 4 — Decide
Initiate glucocorticoid replacement with hydrocortisone (8 mg/m²/day in three or four divided doses) or cortisone acetate (20–35 mg/day in two or three divided doses); avoid prednisolone and dexamethasone entirely.

## Clinical Guardrails / Mimics / Pitfalls
Do not use dexamethasone due to high risk of Cushingoid side effects and difficulty in dose titration. Avoid prednisolone in children with PAI as it is long-acting and may cause overexposure; if hydrocortisone is unavailable, prednisolone is a last-resort alternative only with extreme caution (per guideline 3.3), but dexamethasone remains least preferred.

## Concrete Clinical Example
A 6-year-old girl with PAI (autoimmune etiology) is started on hydrocortisone 9 mg/m²/day in three divided doses (5 mg/m² morning, 2 mg/m² noon, 2 mg/m² evening) after confirming low cortisol and high ACTH. Prednisolone and dexamethasone are avoided per guideline 3.19.

**Source:** Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI: 10.1210/jc.2015-1710