Adrenal Insufficiency

What Is Adrenal Insufficiency?

Adrenal insufficiency happens when the adrenal glands make fewer hormones than they should. This can cause:

• weakness
• tiredness
• belly pain
• loss of appetite
• nausea
• dehydration
• skin changes

Some people with adrenal insufficiency have no symptoms unless they're exposed to stress.

What Are the Adrenal Glands?

There are two adrenal (eh-DREE-nul) glands, which sit above the kidneys. They make important hormones that:

• help the body handle stress
• control blood pressure
• balance salt levels

What Causes Adrenal Insufficiency?

There are two types of adrenal insufficiency:

• In primary adrenal insufficiency, the adrenal glands either are damaged or have a genetic problem. They don't make enough of the hormone cortisol. Sometimes, they also don't make enough of the hormone aldosterone, which helps control salt balance in the body.
• In central adrenal insufficiency, the pituitary gland in the brain doesn't make enough of adrenocorticotropic hormone (ACTH), which triggers cortisol production in the adrenal glands.

There's also a temporary type of adrenal insufficiency. This can happen if someone is being treated with high doses of cortisol-like medicines, such as prednisone, and the medicine is suddenly decreased or stopped.

How Is Adrenal Insufficiency Diagnosed?

Doctors diagnose adrenal insufficiency with blood tests to check hormone levels. They also might order: 

• an ACTH stimulation test to see how the body responds to an injection of adrenocorticotropic hormone
• magnetic resonance imaging (MRI) to check the size and shape of the pituitary gland

How Is Adrenal Insufficiency Treated?

Doctors treat adrenal insufficiency by giving replacement hormones. They might prescribe:

• a corticosteroid taken by mouth several times a day to replace cortisol
• a medicine called fludrocortisone taken by mouth to replace aldosterone and balance the body's levels of salt and fluids

Corticosteroid doses often need to increase during times of illness or stress.

What Is an Adrenal Crisis?

Sometimes, symptoms can suddenly become much worse, usually when someone is stressed by illness or injury. This is called an adrenal crisis. It needs medical treatment right away. Someone having an adrenal crisis needs to go to the hospital for IV (given into a vein) fluids and further doses of corticosteroids.

Signs of an adrenal crisis can include:

• vomiting
• belly pain
• severe weakness
• sweating a lot
• confusion
• loss of consciousness

Kids and teens with adrenal insufficiency should:

• always wear a medical alert ID
• always have injectable steroid with them and all caregivers should learn how to use it

When Should I Call 911?

If your child shows signs of an adrenal crisis, give the injectable steroid and call 911 right away.

When Should I Call the Doctor?

Call the doctor if your child:

• has trouble taking the prescribed medicines
• develops signs of an infection, such as a fever, cough, or diarrhea and vomiting
• has a situation that will cause stress in the body, such as an injury or needing surgery

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