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Objectives Adrenal suppression (AS) is a recognised side-effect of high dose glucocorticoid (GC) therapy. AS is associated with potentially life-threatening adrenal crisis (AC) and strategies used to reduce the likelihood of this complication include GC weaning programmes and/or assessing adrenal function. We wanted to assess the real-world incidence of AC in children and young people treated with supraphysiological GC for nephrotic syndrome (NS) or a rheumatological disorder (RD).Methods This was a retrospective observational audit. Data from all children <16 yrs and >1 month who received supraphysiological GC under the care of renal (NS) or rheumatology teams (RD) at a UK tertiary paediatric hospital were assessed. Data were collected for up to 3 years from the date of starting GC with the monthly GC dose and regimen used. Steroid regimens were classified as outlined in Table 1 with supraphysiological GC defined as >2 mg/m2 of prednisolone (or equivalent). The development of AC was assessed by four strategies:Clinic letter review/A+E attendanceAssessing region wide urea and electrolyte resultsClinical codingProactive discussion with respective renal/rheumatology clinical teamsResults 98 patients were included in the study totalling 3430 patient months of follow up. During GC weaning, all NS and 20% of the RD patients were switched to an alternate day regimen whereas the remaining RD patients were not. 14% of the overall study period was spent on supra physiological daily GC and 27% on supra physiological alternate day GC ( table 1). 1 patient had a short synacthen test whilst all other patients had GC stopped without this.Abstract 8019 Table 1 GC Category N=3430 months (%) Supraphysiological Daily GC 483 (14%) Supraphysiological Alternate Day GC 922 (27%) Subphysiological Daily GC 30 (1%) Subphysiological Alternate Day GC 1 (0%) Off GC 1994 (58%) There were no episodes of AC in the patients studied, irrespective of GC category (table 2).Abstract 8019 Table 2 AC Assessment N=98 Clinic Letters/A&E attendance 0 (0%) Electrolyte Abnormalities 0 (0%) Clinical Coding 0 (0%) Conclusions This study suggests that supra-physiological GC can be weaned and stopped safely without formal biochemical assessment in patients with NS and RD. Both renal and rheumatology clinical teams provide families with rapid easy access to advice from specialist teams and this ensures safe practice. Reasons why our practice appears to be safe may include the use of an alternate day weaning regimen in some patients.