7006 Transient Adrenal Suppression in Pediatric Patients following Propofol Infusion: A Case Report

Abstract Disclosure: M. Salama: None. A.N. Lteif: None. Introduction: Intravenous propofol is widely employed for procedural sedation, monitored anesthesia care, and induction of general anesthesia. It can be administered as a bolus or an infusion. While extensively used, reports in adults and animal studies suggest potential implications of propofol on adrenal steroidogenesis. In this study, we present findings detailing transient adrenal suppression in two pediatric patients following propofol infusion. Case: The first case involves a 5-year-old boy diagnosed with left cerebellar high-grade glioma, having undergone tumor resection and proton beam irradiation. Morning cortisol levels measured twice post-propofol sedation (20 mg bolus followed by infusion at a rate of 275 mcg/kg/min prior to radiation therapy were 3.1 and 1.2 mcg/dl (ref range: 2.4-15 mcg/dl), accompanied by an undetectable ACTH level. Subsequent non sedated cortisol testing done four days later revealed a robust reading of 24 mcg/dl, with an ACTH level of 46 pg/ml.The second case is a 4-year-old boy diagnosed with right cerebellar high-grade astrocytoma glioma, who underwent total resection two months before his initial cortisol assessment. Following proton beam irradiation and propofol sedation (20 mg bolus followed by propofol infusion at a rate of 300 mcg/kg/min) for therapy, his morning cortisol obtained 45 minutes after starting propofol infusion was low at 2 mcg/dL (ref range: 2.4-15 mcg/dl). A repeat cortisol test eight days later showed an increase to 5.6 mcg/dL. Notably, neither patient was on exogenous steroids or medications impacting the adrenal axis. Discussion: The transient decline in cortisol and ACTH observed in these cases gains significance as the patients were not on any medication known to potentially induce adrenal suppression. Additionally, the gliomas were not parasellar in location and radiation had just begun. These findings align with prior reports linking propofol administration with the suppression of the hypothalamic-pituitary-adrenal axis. The impact of propofol on adrenal function needs to be considered especially in pediatric patients undergoing procedures or treatments. Conclusion: Our cases shed light on the potential transient influence of propofol on adrenal function in pediatric patients. Further studies are warranted to comprehensively evaluate the effects of propofol injections and infusions on adrenal function in pediatric cohorts. Presentation: 6/3/2024