Adrenal Suppression in Children Symptoms

Know the symptoms and risk factors for adrenal suppression in children; educate yourself on this dangerous, often unrecognized condition. Identifying it and treating it are simple; the catch is that you must test for it specifically. As adrenal suppression is ultimately an endocrine system concern, a child with adrenal insufficiency should be evaluated and treated by a pediatric endocrinologist.

What is Adrenal Suppression?

• Adrenal suppression (insufficiency) occurs when adrenal cortex function is disrupted. Production of two vital hormones, cortisol and aldosterone, is decreased. The struggling adrenal gland may hemorrhage or become infected, losing all function. Adrenal suppression may be primary or secondary.

Primary

• When the gland itself does not function, this is known as primary adrenal insufficiency. The most common cause of primary adrenal suppression is autoimmune destruction of the adrenal glands---the autoimmune destruction may be isolated to the adrenal glands, or may be part of a larger polyglandular autoimmune attack; if you have one autoimmune disorder, you are likely to have others. Examples of autoimmune disorders seen in conjunction with adrenal suppression include Hashimoto's thyroiditis, type 1 diabetes mellitus and lupus.

  Adrenal suppression graduates to Addison's disease when 90 percent of the adrenal cortex is destroyed by antibodies.

  Primary adrenal suppression is unusual to see in children under age 10, but it does occur. This type of adrenal suppression is more often seen in teens and adults.

Secondary

• If the adrenal cortex under-functions in response to another condition, this is known as secondary adrenal suppression or central adrenal insufficiency. When the hypothalamus---the part of the brain responsible for hormone secretion---fails to produce corticotropin releasing hormone (the stress hormone), or the pituitary doesn't release necessary adrenocorticotropic hormone (stimulates the adrenal gland), the adrenal cortex cannot function properly.

  The exact incidence of secondary adrenal suppression in children overall is unknown, however, one in 16,000 infants have it secondary to congenital adrenal hyperplasia---a deficiency of enzyme needed to synthesize cortisol and aldosterone as a result of any number of autosomal (chromosomes not involved in gender) recessive disorders.

Symptoms

• Symptoms include salt craving, fatigue, physical weakness, dizziness, fainting, sweating, irritability, nausea or vomiting, abdominal pain and diarrhea.

Other Causes

• Besides the primary and secondary medical reasons described above, children may experience adrenal suppression in response to the intake of steroids. Children with asthma inhale steroids to ward off attacks. Children with skin conditions like eczema use topical steroids for relief.

  Tuberculosis and HIV may put a strain in the adrenal cortex, causing suppression. In the rare instance that a child has thalassemia (an inherited blood synthesis disorder) and has had transfusions, iron may deposit on the adrenal or pituitary gland, which leads to adrenal suppression.

Significance

• Adrenal suppression can be a life-threatening condition. While some children demonstrate no symptoms, those who do may be misdiagnosed with other conditions that mimic adrenal suppression, like depression or chronic fatigue syndrome. Signs of trouble may not become apparent until acute adrenal suppression has set in. If your child is taking steroids for any other condition, shows any of the symptoms listed above, or is known to have a risk factor such as thalassemia, have your physician keep a close watch on your child. Correct blood tests or urine tests will identify adrenal suppression. Treatment is simple---oral replacement of the hormones that the adrenal gland doesn't make.

  Any of the listed symptoms should be taken seriously as they may indicate adrenal crisis (Addisonian crisis), which untreated can fast become fatal.