The BSPED have prepared the following position statement on the NICE Adrenal insufficiency: identification and management guidance. 

British Society for Paediatric Endocrinology and Diabetes (BSPED) welcomes the value of a national, standardised approach set out in NICE NG243 (August 2024) for children and young people with adrenal insufficiency and those at risk of adrenal suppression. A consistent framework helps clinicians, families, schools, community services, emergency departments, and inpatient teams to work from the same principles—reducing unwarranted variation in care, improving safety-netting, and supporting equitable access to best practice across the UK.

NG243 explicitly aligns key paediatric recommendations with established BSPED practice by cross-referring to BSPED consensus guidance for children and young people under 16 years, for sick-day rules and emergency management of adrenal crisis.

The BSPED position is that NG243 provides a highly useful “umbrella” structure for service delivery and shared care, while enabling paediatric teams to continue using BSPED guidance as the practical foundation for sick-day education, emergency planning, and training resources.

BSPED supports the use of NG243 as a structured approach to identifying and managing risk of adrenal suppression but emphasises that paediatric care must remain individualised. While a national guideline supports standardisation, clinicians must still take account of:

• age and developmental stage (including infant feeding and early childhood vulnerability)
• comorbidities and neurodisability
• family capacity and safeguarding considerations
• access to urgent care, and
• the underlying disease requiring glucocorticoids and the clinical risk of relapse.