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Underactive Adrenal Glands/Addison's Disease in Children

What is Addison's disease?

Addison's disease occurs when the adrenal glands are not able to produce an adequate amount of steroid hormones. An underactive adrenal gland produces insufficient amounts of cortisol (a steroid hormone that helps to control the body's use of fats, proteins, and carbohydrates, suppresses inflammatory reactions in the body, and affects immune system functions) and aldosterone (a steroid hormone that controls sodium and potassium in the blood). Addison's disease is considered rare. Onset of the disease may occur at any age.

What causes Addison's disease?

Destruction of the adrenal gland due to an autoimmune response is the most common cause of the disease. Some Addison's disease cases are caused by the actual destruction of the adrenal glands through cancer, infection, an autoimmune process, or other diseases. Other causes may include the following:

  • Use of corticosteroids as a treatment (such as prednisone) leading to a slowdown in production of natural corticosteroids by the adrenal glands.

  • Certain medications used to treat fungal infections may block production of corticosteroids in the adrenal glands.

  • Rarely, Addison's disease is inherited.

What results from inadequate corticosteroid production?

Lack of adrenal hormones may cause:

  • Elevated levels of potassium, which affect the balance of that element with water and sodium.

  • Extreme sensitivity to the hormone insulin, which normally is present in the bloodstream. This sensitivity may lead to low blood sugar levels.

  • Increased risk during stressful periods, such as surgery, infection, or injury. Corticosteroids play an important role in helping the body fight infection and promote health during physical stress.

What are the symptoms of Addison's disease?

Mild Addison's disease symptoms may only be apparent when the child is under physical stress. The following are the most common symptoms of Addison's disease. However, each child may experience symptoms differently. Symptoms may include:

  • Muscle weakness

  • Fatigue

  • Dizziness

  • Rapid pulse

  • Dark skin (first noted on hands and face)

  • Black freckles

  • Bluish-black discoloration around the nipples, mouth, rectum, scrotum, or vagina

  • Weight loss

  • Dehydration

  • Loss of appetite

  • Intense salt craving

  • Muscle aches

  • Nausea

  • Vomiting

  • Diarrhea

  • Intolerance to cold

If not treated, Addison's disease may lead to severe abdominal pain, extreme weakness, low blood pressure, kidney failure, and shock--especially when the child is experiencing physical stress. The symptoms of Addison's disease may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How is Addison's disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Addison's disease may include blood tests to measure corticosteroid hormone and potassium levels.

Treatment of Addison's disease:

Specific treatment for Addison's disease will be determined by your child's doctor based on:

  • Your child's age, overall health, and medical history

  • Extent of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

The goal of treatment is to replace the deficient hormones and relieve the symptoms of hormone deficiency. Since Addison's disease can be life-threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as cortisol, may be taken orally or intravenously, depending on the child's condition. Usually the child must continue taking the corticosteroids for the rest of his or her life. Treatment may also include taking a medication that helps restore the body's level of sodium and potassium.