The adrenals are triangular-shaped glands that sit on top of each kidney. They contain two types of tissue. The inner medulla secretes hormones like adrenaline or epinephrine that help the body's response to stress by increasing heart rate, blood pressure and sweating. The outer cortex secretes the hormones cortisol and aldosterone, which help maintain the body's electrolyte and fluid balance. The adrenals also secrete sex hormones, like testosterone.
Function
The main function of the adrenal glands is the secretion of hormones important to the daily function of the body. The adrenals respond to signals from the brain, in particular from the pituitary gland via a hormone called ACTH, to produce hormones. In response to ACTH, the adrenal glands produce steroid hormones called glucocorticoids, like cortisol, which help both the immune system and also help the body maintain a steady level of glucose, the main sugar used in the tissues for normal cellular processes. The adrenals also secrete a second class of hormones, called mineralocorticoids, which act on the kidneys to regulate the reabsorption of sodium and water, a mechanism of vital importance to maintain appropriate fluid balance in the body.
Effects
Children can have disorders that cause overproduction or underproduction of adrenal hormones. According to the Morgan Stanley Children's Hospital website, two of the most common adrenal disorders in children are Cushing's syndrome and Addison syndrome. Cushing's syndrome is a condition in which the adrenals produce too much cortisol. Children with Cushing's syndrome have excessive weight gain with upper body obesity and increased fat around the neck, growth retardation, high blood pressure, fatigue, muscle weakness and high blood sugar. Children with Addison's disease have an under-active adrenal gland. These children exhibit weakness, fatigue, dizziness, dehydration, loss of appetite and salt craving.
Identification
The diagnosis of adrenal function disorders in children relies on a combination of history, physical characteristics and laboratory findings.
Children with Cushing's syndrome are often first noticed by their upper body obesity and fat between their shoulders, which can give the impression of a hump. They also have rounded "moon faces." On laboratory testing, their blood sugar is elevated, which can make the child exhibit symptoms that may be mistaken with diabetes, like increased thirst, increased urination and increased eating. A 24-hour collection of urine can help determine the total amount of cortisol in the body.
Children with Addison's disease have low blood pressure and may have abnormal darkening of their skin. These children will often have problems with their electrolytes, like high calcium and potassium, low blood sugar, and low sodium.
Considerations
Children with Addison's disease can go into an "Addisonian" or adrenal crisis. This results from the severe lack of adrenal hormones. This is an emergency that requires prompt medical attention. Patients with an adrenal crisis have severe vomiting and diarrhea, low blood pressure and low blood sugar, which can then go on to lethargy, confusion and seizures.
Prevention/Solution
Frequent administration of steroids can also affect the adrenal glands, leading to Cushing's syndrome. If a child takes steroids over a long period of time, it is important to monitor physical characteristics and blood tests to ensure the adrenal glands are working properly. Removal of the source of excess cortisol usually fixes Cushing's syndrome. For Addison's disease, lifelong supplementation of the missing adrenal hormones reduces the chances of having an adrenal crisis.
