Adrenal Insufficiency: Causes of Adrenal Insufficiency and Prevention of Adrenal Crisis

Abstract

Adrenal insufficiency (AI) is defined as the body's inability to produce enough adrenal hormones. Cortisol and aldosterone maintain normal physiologic functions in the body such as blood pressure, glucose levels and sodium/water balance in the body. Adrenal insufficiency can be primary or secondary, congenital or acquired. The most common form of primary adrenal insufficiency in children is congenital adrenal hyperplasia (CAH), with an incidence of about 1 in 15,000. A much more common cause of acute adrenal insufficiency is glucocorticoid withdrawal in patients being treated with chronic pharmacologic doses of steroids. The prevalence of secondary adrenal insufficiency is 150–280 per million. Causes of permanent AI include: Addison disease, CAH, complete removal of pituitary gland, surgical removal of the adrenal gland. Temporary causes are surgical removal of tumor from the pituitary gland, removal of cortisol producing tumors, medical treatments that lower cortisol levels to treat Cushing syndrome, and taking steroids for prolonged periods. The purpose of this poster is to identify and explain the causes of adrenal insufficiency, explain the daily management versus the illness regimen, and review the sick day rules and injection teaching of intramuscular hydrocortisone to prevent adrenal crisis. Nursing interventions to prevent adrenal crisis are to educate parents about sick day rules and provide intramuscular injection teaching to parents of children on glucocorticoid therapy. Even though there are adequate treatments for adrenal crisis, it continues to be a cause of morbidity and mortality in children. Children are at increased risk during times of illness and surgical procedures. There are many children taking glucocorticoid therapy for multiple diseases. Giving exogenous glucocorticoids turns off the body's natural ability to produce extra cortisol in times of physiologic stressors. Prevention of the crisis with correct dosing for physiologic stressors such as fever or trauma is an important goal. Pediatric endocrine nurses can provide patients and their families with the tools to prevent crisis by knowing the symptoms, causes, and tools to use in case of emergency.