Imagine a child who’s constantly tired, has little appetite, and gets sick more often than other kids. These could just be the signs of a viral bug—or they could be something far more serious: adrenal insufficiency (AI).
Although rare, adrenal insufficiency in children is a potentially life-threatening condition that that demands prompt recognition and effective management. The tricky part? Its early symptoms often hide in plain sight. But with the right awareness, timely diagnosis, and effective treatment, children with AI can live full, healthy lives.
Let’s explore what this condition is, why early detection is crucial and how to manage it.
What Is Adrenal Insufficiency?
The adrenal glands are located above the kidneys, produce hormones essential for life especially cortisol, aldosterone and androgens. These hormones help regulate blood pressure, metabolism, and the body’s response to stress.
Adrenal insufficiency refers to inadequate production of adrenal hormones. It can be classified into two main types:
- Primary Adrenal Insufficiency: This occurs due to direct dysfunction or destruction of the adrenal glands. It is caused often by genetic disorder like congenital adrenal hyperplasia and autoimmune condition like Addison’s disease.
- Secondary Adrenal Insufficiency: Adequate functioning of the adrenal glands is stimulated by a hormone called adrenocorticotropic hormone (ACTH) produced by pituitary gland in the brain. Secondary Adrenal Insufficiency arises from inadequate stimulation of the adrenal glands by this adrenocorticotropic hormone (ACTH) due to problems in the pituitary gland like pituitary tumours.
Both types of adrenal insufficiencies can significantly impact a child’s growth, development, and overall health if not promptly recognized and managed.
Why Early Detection Matters?
Early detection of adrenal insufficiency can be crucial for a child’s health. Parents are thus advised to stay vigilant and recognize the signs of early disease, to help their children get the best of health. Here is why early detection matters.
Prevention of Adrenal Crisis
The adrenal crisis (an acute adrenal insufficiency) is a life-threatening medical emergency that happens when the body doesn’t have enough cortisol, a critical stress hormone produced by the adrenal glands.
Cortisol helps the body to respond appropriately to situations of stress (like infections, injuries & surgeries) by regulating blood pressure, blood sugar, salt balance, and heart function. In children with adrenal insufficiency, cortisol is not produced in situations of stress resulting in adrenal crisis. If these children are appropriately managed, such a crisis can be prevented.
Protection of Growth and Development
Cortisol plays an important role in the growth and development of the children. Unrecognized adrenal insufficiency can lead to faltering growth. Early diagnosis ensures hormone replacement therapy which can support normal development in a child.
Reduction of Morbidity
Children with undiagnosed adrenal insufficiency often experience recurrent episodes of vomiting, dehydration, low sugars, and fatigue. These symptoms affect their school attendance, social interactions, and overall quality of life. Early diagnosis and management of this condition promotes a more active and healthy childhood.
Improved Family Education and Preparedness
An early diagnosis equips families with knowledge about the condition. Parents can be trained to recognize early signs of adrenal stress and respond promptly with stress doses of hydrocortisone or seek medical attention, thereby averting crises.
The Sneaky Symptoms of Adrenal insufficiency (AI):
One of the biggest challenges in diagnosing AI in children is that its symptoms are vague and mimic many common illnesses:
- Persistent fatigue
- Poor appetite or weight loss
- Nausea/vomiting and abdominal pain
- Low blood pressure
- Darkening of the skin (Hyperpigmentation)
- Low blood sugars
- Faltering growth
Because these symptoms aren’t unique to AI, it’s easy to miss the warning signs—until a sudden adrenal crisis hits. This can involve severe dehydration, salt imbalances and dangerously low blood pressure, and is a medical emergency.
Diagnosis: Catching It Early
Early referral to a pediatric endocrinologist for confirmation and management is often necessary. A pediatric endocrinologist is an expert who deals with hormonal conditions in children.
Diagnosing AI requires a combination of clinical judgment and of blood tests:
- Morning serum cortisol test: Low levels may indicate AI.
- ACTH stimulation test: Evaluates the adrenal gland’s ability to produce cortisol.
- Electrolyte testing: Detects salt imbalances like low sodium or high potassium.
Managing Adrenal Insufficiency: A Lifelong but Livable Condition
The good news is that once diagnosed, adrenal insufficiency can be effectively managed.
- Daily hormone replacement: Most children take hydrocortisone and fludrocortisone.
- Stress dosing: During illness or surgery, children need increased doses of hydrocortisone to mimic how the body normally responds to stress.
- Emergency preparedness: Families should always have injectable hydrocortisone with them and be trained to use it.
- Regular Monitoring
Children on long-term steroid replacement require regular monitoring to ensure adequate dosing without overtreatment.
Monitoring includes checking:
-Growth parameters (height & weight)
-Blood pressure
-Electrolyte levels
-Pubertal development
-Bone health (as long-term steroid therapy can impact bone density)
Regular adjustments in the doses of medications are necessary as the child grows
It’s also vital that children wear a medical alert bracelet and that schools and caregivers understand how to respond in case of an adrenal crisis.
Special Considerations
Neonatal Screening
Screening will pick up congenital adrenal hyperplasia (the most common cause of primary adrenal insufficiency in children) and we can therefore manage this condition in a timely manner without any complications.
Disorders of Sex Development (DSD) and Adrenal Insufficiency
Disorders of Sex Development (DSD) refers to conditions where there is atypical development of external genitalia. One important cause of DSD is Congenital Adrenal Hyperplasia (CAH) a genetic disorder that also leads to adrenal insufficiency.
In CAH, a deficiency of key enzymes disrupts cortisol and aldosterone production in the adrenal glands. To compensate, the body overproduces androgens (male hormones), which can cause virilization (masculinization) of external genitalia in newborn girls and can lead to atypical external genitalia at birth. In boys it causes virilization and hyperpigmentation of the external genitalia. At the same time, lack of cortisol and aldosterone puts the child at risk of life-threatening adrenal crisis.
Early diagnosis through newborn screening and prompt management with hormone replacement therapy are crucial to stabilize the child’s health.
Final Thoughts
Adrenal insufficiency may be rare, but that’s no reason to let it slip under the radar. Early recognition by both parents and healthcare professionals can make all the difference between control and crisis.
While many causes are genetic or autoimmune and thus not preventable, early newborn screening for conditions like congenital adrenal hyperplasia can detect adrenal insufficiency early and prevent serious complications.
If your child shows unexplained fatigue, low blood pressure, or frequent illness, it’s worth discussing adrenal function with your doctor. Because when it comes to adrenal insufficiency, early action isn’t just helpful, it’s lifesaving.
FAQ’s for Early Detection of Adrenal Insufficiency in Children: Signs, Symptoms, Causes Diagnosis and Treatment Options
Adrenal insufficiency is a condition where the adrenal glands do not produce enough important hormones like cortisol and aldosterone. It can severely affect a child’s metabolism, growth, and response to stress.
It can be caused by direct damage to the adrenal glands (primary adrenal insufficiency), such as autoimmune diseases, infections like tuberculosis, or genetic disorders like congenital
adrenal hyperplasia. It can also result from pituitary or hypothalamic dysfunction (secondary adrenal insufficiency).
Symptoms include chronic fatigue, poor appetite, weight loss, vomiting, salt craving, low blood pressure, hyperpigmentation, delayed puberty, hypoglycemia, and irritability.
Early diagnosis can prevent life-threatening adrenal crisis, protect normal growth and brain development, reduce hospitalizations, and improve the child’s overall quality of life.
Diagnosis typically involves blood tests to measure cortisol, ACTH, electrolytes (like sodium and potassium), and blood glucose levels. Imaging like an MRI may be needed in some cases to evaluate the pituitary or hypothalamus.
An adrenal crisis is a severe, life-threatening emergency caused by extremely low cortisol levels, leading to shock, dehydration, dangerously low blood pressure, low blood sugar, and even death if untreated.
Treatment involves daily hormone replacement therapy. Stress dosing adjustments and emergency planning are crucial parts of care.
During illness, surgery, or injury, the child’s cortisol needs increase. Parents must follow the stress-dosing plan given by their doctor, which may involve giving higher doses of hydrocortisone or administering an emergency injection.
Yes, with proper diagnosis, treatment, regular monitoring, and education on emergency preparedness, children with adrenal insufficiency can lead healthy, active lives.
While many causes are genetic or autoimmune and thus not preventable, early newborn screening for conditions like congenital adrenal hyperplasia can detect adrenal insufficiency early and prevent serious complications.
Author: Dr. Kavitha Sakamuri
Consultant Pediatrician & Pediatric Endocrinologist
