The adrenals, a pair of triangular-shaped glands that sit atop each kidney, secrete the hormone cortisol. Cortisol is a steroid hormone that helps regulate the immune system and the body's response to stressful situations. The levels of cortisol vary during the day, peaking in the morning and decreasing during the afternoon. Cortisol deficiency in children is usually caused by adrenal insufficiency.
Causes
According to the National Endocrine and Metabolic Diseases Information Service, there are two types of adrenal insufficiency. Primary adrenal insufficiency, also known as Addison's disease, results from the inability of the adrenal glands to produce and secrete cortisol. Secondary adrenal insufficiency occurs when the pituitary gland, a pea-sized gland at the base of the brain, cannot produce enough ACTH, the hormone that stimulates production of cortisol in the adrenals.
Symptoms
The symptoms of cortisol deficiency in children include chronic fatigue, weight loss, muscle weakness, loss of appetite, nausea, vomiting, diarrhea and dehydration. Children can also experience drops in blood pressure, irritability, depression, low blood sugar and craving salty foods. Occasionally, children will have dark skin patches, particularly around scars.
Diagnosis
The diagnosis of cortisol deficiency starts by checking a cortisol level, particularly in the early morning, when it is supposed to peak. According to Lab Tests Online, another confirmatory test is the ACTH stimulation test. In this test, a child receives intravenous ACTH and the levels of this hormone in the urine and the blood are measured. A normal response is an increase in the cortisol level after ACTH injection. Failure of the cortisol level to increase indicates adrenal insufficiency.
Treatment
Treatment of adrenal insufficiency includes replacing the missing cortisol with other similar steroids hormones, like dexamethasone, hydrocortisone or prednisone. Some children also need replacement of mineralocorticoids, steroids that the adrenal glands also produce and that regulate the levels of salt in the body.
Adrenal Crisis
An adrenal, or Addisonian, crisis occurs when the child experiences an acute illness that suddenly worsens the symptoms of cortisol deficiency. This can be a life-threatening condition. The symptoms of an adrenal crisis include a sudden pain in the back, abdomen and legs; severe vomiting and dehydration; low blood pressure; and loss of consciousness. Treatment for an adrenal crisis includes the rapid replacement of glucose-containing intravenous fluids and steroids.
