Adrenal insufficiency is a condition in which the body is unable to produce normal amounts of the hormone cortisol and — in some cases — the hormone aldosterone. This usually happens due to damage to the adrenal glands (also called Addison’s disease), where these hormones are produced. Adrenal insufficiency can also happen when the brain fails to produce ACTH, which is the signal that regulates adrenal function.
Cortisol helps the body respond to an illness or injury. It also stabilizes blood pressure and blood sugar levels. Aldosterone helps keep the body’s salt and water levels balanced.
The body produces more cortisol during an illness, injury or a procedure like surgery. People who are unable to make cortisol may be unable to recover from an injury like a broken bone or other illness unless they are treated with high or “stress” doses of cortisol.
Children with adrenal insufficiency may experience:
- Slow weight gain
- Fatigue and generalized weakness
- Low blood pressure
- Salt cravings
They may also appear unusually tanned or have darkened skin creases, gums and scars.
During an illness, such as an infection, the child may develop “adrenal crisis." Adrenal crisis usually starts with vomiting and may quickly progress to a severe illness associated with abnormally low blood pressure, low blood sugar, a salt/water imbalance, lethargy and shock.
Addison’s disease most commonly occurs when the body’s immune system mistakenly attacks and damages the adrenal glands.
Adrenal insufficiency may also be caused by:
- Certain genetic diseases such as congenital adrenal hyperplasia or adrenal leukodystrophy.
- Various infections that can damage the adrenal gland.
- Bleeding in the adrenal glands.
- Surgery involving the adrenal glands.
- A decrease in ACTH, a hormone that regulates cortisol secretion, due to genetic conditions, tumors or infections around the pituitary gland in the brain.
- Long-term steroid therapy, such as hydrocortisone, prednisone or dexamethasone, which are used to treat rheumatology, severe asthma and immune conditions. These steroids can suppress the hypothalamic-pituitary-adrenal (HPA) axis.
Adrenal insufficiency is diagnosed with a special blood test that measures the amount of cortisol in the body.
Additional tests, such as Cortrosyn or CRH stimulation tests, may be done to better understand the ability of the body to produce cortisol or ACTH.
Your child’s doctor may also order imaging tests, such as X-rays, ultrasound or CT of the adrenal gland, or an MRI of the brain.
Adrenal insufficiency is treated with cortisol replacement therapy given as a tablet on a daily basis. Patients who are unable to make aldosterone are also placed on aldosterone replacement which is given as a pill daily).
Children with adrenal insufficiency will need high doses or “stress” doses of cortisol replacement during an illness, injury or procedures such as surgery. In some emergency situations, when your child is sick and unable to tolerate taking the medicine by mouth (i.e. unable to swallow or keep the pills down due to vomiting), you may need to give cortisol as an injection.
Children with adrenal insufficiency need regular follow up and blood testing. Monitoring is essential to avoid symptoms of adrenal insufficiency and ensure proper growth and development.
With proper diagnosis and treatment, the symptoms of adrenal insufficiency can resolve or be well-controlled. Children with this condition are able to live normal lives and participate fully in school and other activities.
If your child has an underlying condition that requires ongoing therapy, such as congenital adrenal hyperplasia (CAH), daily cortisol can help manage symptoms over the long term. If the adrenal insufficiency is due to tapering off of long-term steroid use, hormone replacement therapy may only be needed temporarily. Children on long-term steroid use need to be slowly tapered off the steroids to allow their body time to “wake up” and begin producing its own steroid hormones again.
At CHOP’s Adrenal and Puberty Center, your child will have access to a multidisciplinary team of specialists with extensive experience in the treatment of adrenal disorders. We have established programs to educate families about adrenal insufficiency and how to care for a child at risk for adrenal crisis.
We closely monitor all children in our care, ensuring they receive psychosocial support, nutritional counseling, access to various subspecialties according to their needs, and coordination of care.