What Are Adrenal Insufficiency Symptoms?

Adrenal insufficiency is a series of clinical manifestations caused by inadequate secretion of cortisol and / or aldosterone in the adrenal cortex caused by many congenital or acquired causes. Due to the different etiology and pathology, the clinical manifestations are quite different. The onset of onset, age of onset, long duration of disease, and severity of disease are significantly different.

Basic Information

English name: pediatric adrenal insufficiency
Visiting department: Pediatrics
Multiple groups: Children
Common locations: Adrenal gland

Common causes: Defects or lesions on any part of the hypothalamus-pituitary-adrenal axis
Common symptoms: Vomiting, nausea, difficulty feeding, no weight gain, lethargy, dehydration, hypothermia, hypoglycemia, circulatory failure, etc.

Causes of Pediatric Adrenal Insufficiency

Defects or lesions on any part of the hypothalamus-pituitary-adrenal axis can cause adrenal insufficiency, such as:

1. Congenital hypoplasia or hypoplasia.

2. Primary adrenal hypoplasia or underdevelopment.

3. Congenital defects in adrenocortical hormone synthesis.

4. Familial glucocorticoid deficiency.

5. Adrenal insufficiency in children due to destructive adrenal lesions such as tuberculosis, histoplasmosis, coccidioidomycosis, fungal disease, amyloidosis and metastatic cancer is Addison's disease.

6. Adrenal white matter malnutrition.

7. Adrenal hemorrhage, bleeding during neonatal period due to dystocia or asphyxia.

8. Warford Syndrome.

9. Suddenly stop corticosteroids or adrenocorticotropic hormones.

10. Insufficient aldosterone synthesis is an autosomal recessive inheritance.

11. Pseudo hypoaldosterone, an autosomal recessive inheritance.

Clinical manifestations of adrenal insufficiency in children

Symptoms, age of onset, and manifestations vary depending on the disease. The clinically visible types are as follows:

1. Acute adrenal insufficiency

Infancy usually occurs when the adrenal glands are not developed, steroid hormone synthesis is deficient, and pseudohyperaldosteronism. Symptoms of salt loss can begin shortly after birth with vomiting, nausea, difficulty feeding, weight loss, lethargy, dehydration, hypothermia, hypoglycemia, and circulatory failure. If diagnosis and treatment are not timely, death can be rapid.

2. Chronic adrenal insufficiency (Addison's disease)

Onset is slow, with early symptoms of gradual feeling of fatigue, weakness, long-term loss of appetite, nausea, vomiting, diarrhea, weight loss, hypotension, etc. The symptoms of abdominal pain are similar to acute abdomen. More like salt and drinking water, if insufficient salt intake and untimely treatment can cause adrenal crisis, cyanosis, cold skin, weak and fast pulse, blood pressure drop, fast and laborious. Skin pigmentation often appears on the face, palm prints and fingerprints, perineum, nipples, umbilicus and joints. Sometimes white spots are visible on the skin and melanin spots occur on the mucosa. Under stress, the condition can suddenly worsen, and convulsions and coma occur in adrenal crisis.

3. Adrenal crisis

Adrenal crisis occurs during acute infection, especially when meningococcal septicaemia (also seen in sepsis caused by pneumococcus, streptococcus, etc.), severe shock soon enters the coma, and there is acute purpura, which is the point of skin bleeding Soon it expanded and merged into large ecchymosis, blood pressure decreased, pulse rate increased, breathing difficulties, skin cyanosis, and chills. The decrease in blood sodium can be masked by the concentration of blood. Clinically known as fulminant meningococcal or Huafo syndrome, adrenal hemorrhage is only a pathological diagnosis. The main cause of circulatory failure is microcirculation disorders due to toxemia.

Pediatric adrenal insufficiency test

Electrolyte

Decreased blood sodium and chlorine concentration, increased blood potassium, increased urinary sodium and chlorine, decreased potassium excretion. Increased blood urea nitrogen and non-protein nitrogen may occur during dehydration. Plasma renin increases, generally hypoglycemia is not obvious, and prolonged fasting time may occur hypoglycemia.

2. peripheral blood

Eosinophil count increased.

3. Determination of corticosteroids in blood and urine

In general, reduced or normal blood or urine cortisol levels are important diagnostic criteria.

4. Adrenocorticotropic hormone stimulation test

Corticosteroid secretion cannot be increased during the experiment, indicating that the lesion is in the adrenal gland and lacks reserve capacity; if corticosteroids are significantly increased after adrenocorticotropin, the lesion is not in the adrenal gland but in the pituitary or hypothalamus. In order to test the pituitary's reserve function, a test can also be performed with mepidone. If there is a primary lesion in the adrenal cortex, this test cannot reflect the pituitary's reserve capacity.

5. Adrenocorticotropic hormone concentration in blood

Elevation is a primary cortisol deficiency, such as a decrease in cortical function secondary to the pituitary or hypothalamus.

6. Blood and urine aldosterone

When insufficient aldosterone secretion is suspected, blood and urine aldosterone should be measured, which is of significance for distinguishing between simple insufficient aldosterone synthesis and pseudohypoaldosteronism.

7. ECG

It can be seen that there are changes in hyperkalemia, T wave peaks, ST segment decline, PR interval prolongation, arrhythmia and so on.

8. EEG

Normal or low voltage, fast frequency waves are reduced.

9. Other

Ultrasound or CT of the abdomen can also be helpful for diagnosis.

Diagnosis of adrenal insufficiency in children

Adrenal insufficiency can be diagnosed based on medical history, clinical manifestations, and laboratory results. Laboratory tests can further determine whether the lesion is in the adrenal glands or in the pituitary.

Differential diagnosis of adrenal insufficiency in children

Diseases that need to be distinguished from adrenal insufficiency need to be considered. In the neonatal period, vomiting, diarrhea, dehydration and other salt loss manifestations should be distinguished from pyloric obstruction and severe indigestion. Skin pigmentation must be distinguished from other skin pigmented diseases, such as neurofibromatosis.

Complications of adrenal insufficiency in children

Acute children can develop dehydration, hypoglycemia, and circulatory failure, and can die quickly if diagnosis and treatment are not timely. Chronic children can lose weight, hypotension quickly expands and merge into large ecchymoses, blood pressure drops, pulse rate increases, dyspnea, skin cyanosis, coldness, insufficient salt intake, and untimely treatment can cause adrenal crisis. Convulsions and coma; Warfor syndrome can occur in acute infections, especially in meningococcal sepsis.

Treatment of adrenal insufficiency in children

1. Treatment of acute adrenal insufficiency and adrenal crisis

Correct water and electrolyte disorders, use hydrocortisone, and control infection.

2. Treatment of chronic adrenal insufficiency

Hormone replacement therapy. Cortical insufficiency, such as the adrenal cortex, does not respond to corticotropin, hypoglycemia may occur, and sugar fluid must be given. Most patients have no problems with anhydrous salt metabolism. If secondary to adrenocorticotrophic hormone deficiency, and no aldosterone secretion disorders, most patients with symptoms of cortical dysfunction under stress, should be treated with hydrocortisone. If the kidneys of infants do not respond to corticosteroids, the symptoms of salt loss cannot be corrected with corticosteroids, a large amount of salt must be added, and the children can resolve the symptoms on their own within 15-20 months. If there is both thyroid and adrenal insufficiency, only using thyroid hormone instead of treatment can cause acute adrenal insufficiency in children. Thyroxine and hydrocortisone should be used for treatment at the same time, or hydrocortisone treatment should be started first. . If adrenal insufficiency and hypopituitarism coexist simultaneously, diabetes insipidus may not appear before treatment, and diabetes insipidus may occur after treatment with hydrocortisone.

Prevention of adrenal insufficiency in children

1. The etiology of adrenal insufficiency is more complex and diverse. First of all, the occurrence of iatrogenic adrenal insufficiency should be prevented. The long-term use of exogenous corticosteroids can cause adrenal atrophy and hypofunction, and it suddenly stops after long-term medication When you encounter stress after taking the drug or discontinuation of the drug, acute adrenocortical dysfunction due to insufficient secretion of corticosteroids in the body, or even a crisis reaction such as crisis, the preventive measure is a reasonable stepwise withdrawal of the drug, which may be given if necessary. Corticotropin.

2. Adrenal insufficiency can occur in adrenal cortex tuberculosis, histoplasmosis, coccidiosis, mycosis, amyloidosis, and metastatic cancer, etc. Warfar syndrome is caused by bacterial infection of adrenal insufficiency. Actively prevent the occurrence of infection, including doing a variety of vaccination work.

3. Adrenal hemorrhage due to dystocia or asphyxia in the neonatal period can lead to this disease, and perinatal medical work should be done to reduce dystocia or suffocation and do rescue work for newborns.

4. Congenital pituitary hypoplasia or underdevelopment, primary adrenal hypoplasia or underdevelopment, familial glucocorticoid deficiency, adrenal white matter malnutrition, etc. Genetic prevention should be done for X-linked inheritance and autosomal inheritance Work, and by culturing adrenal and cerebral cortical fibroblasts amniotic fluid and chorionic biopsy, prenatal diagnosis can be done to take corrective measures.