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Secondary adrenal suppression is a well-established complication of high dose corticosteroid use in paediatric inflammatory bowel disease (PIBD) patients. At our institution standard practice is an initial screening with a morning cortisol at the end of the steroid course. If suppressed below 250nmol/L, hydrocortisone replacement is initiated. Cortisol levels 250-400 would lead to a repeat at 28 days. After a period of on replacement, determined by the endocrine department, a short synachthen test (SST) is performed to assess for ongoing adrenal suppression. Only if normal is replacement therapy stopped. This study aims to evaluate a single centre’s experience with this management, as well as to identify factors that may be associated with prolonged periods of adrenal insufficiency.Paediatric patients with both PIBD and evidence of Adrenal suppression under the care of a single major centre between 2017-2022 were identified using the endocrine department’s database of all patients undergoing an SST, due to an initially low morning cortisol during this period, and then cross referencing them with a PIBD database. From review of the electronic patient records (EPR) age, IBD subtype, duration of steroid courses, first cortisol level, result of SST, total length of hydrocortisone replacement and results of any subsequent SSTs was collatedBetween 2017-2022, 435 children aged between 0-18 years, were treated for IBD at this centre. Nineteen children (4.3%) were identified with the need for hydrocortisone replacement therapy and then at least one subsequent SST during this period. Diagnoses were UC 36.8% (n=7), Crohn’s 52.6% (n=10) and IBDU 10.5% (n=2). Adrenal suppression was still present in 52.6% (n=10) of children by the time of their first SST, therefore requiring ongoing hydrocortisone treatment and a further SST. Median steroid course duration prior to first cortisol was 7 months, and median steroid replacement therapy was for 17 months; the longest duration of steroid replacement was 49.5 months. Pearson’s correlation was performed between the length of hydrocortisone replacement and the following factors: duration of high dose steroid course (p=0.24), age (p=0.14) and initial suppressed cortisol level (p=0.14) None were statistically significant. Comparison of Crohn’s vs UC groups was dichotomised around the mean hydrocortisone duration (> or < 20 months) and was also not significant different (Chi-test, p=0.8)The results show that a significant number of children continue to require steroid replacement therapy by their first check SST. That a very wide range of duration is seen indicating unpredictable recovery.This reinforces the importance of identifying factors that may contribute to children requiring longer courses of steroid replacement to best tailor their follow up reviews. Our lack of statistically significant results highlights the need for a larger cohort of PIBD patients with adrenal insufficiency to further evaluate for this. That around 25% of the group had a normal SST by 6 months, suggests that this may be a target timescale for the first SST.