Early recognition and treatment of adrenal crisis in children

Abstract

Adrenal crisis is a life-threatening emergency caused by the destruction or altered function of the adrenal gland with a primary deficit in cortisol secretion(primary adrenal insufficiency) or by hypothalamic-pituitary pathologies determining a deficit of adrenocorticotropic hormone(secondary adrenal insufficiency). Infection and abrupt end glucocorticoid treatment are the major precipitating causes of adrenal crisis.Patients with adrenal crisis typically present with hypovolemic shock or hypotension, nausea, vomiting, and fever responding well to parenteral hydrocortisone administration.The main laboratory findings include lower serum cortisol concentrations, hyponatremia, hypoglycaemia and/or hyperkalemia.Delay diagnosis of adrenal insufficiency leads to adrenal crisis which is potentially lethal complication.Empirical glucocorticoid replacement should be initiated as soon as the suspicious of adrenal crisis, or sooner if the patient presents in adrenal crisis in critically ill children. Key words: Adrenal crisis; Adrenal insufficiency; Diagnosis; Treatment; Children,