Adrenal Insufficiency: Diagnosis and Treatment

How do doctors diagnose adrenal insufficiency?

We often diagnose adrenal insufficiency through a blood test for hormones called cortisol and adrenocorticotropic hormone (ACTH). We draw the blood sample close to 8 am.

Sometimes, we draw blood for certain other hormones (such as 17-hydroxy progesterone and DHEA-s). We might need to do a test called an ACTH stimulation test. This test measures how well your child’s adrenal glands respond to a medication called cosyntropin, which is an artificial form of ACTH. For this test, we give your child an injection of cosyntropin. Then, we measure your child’s hormone levels in his or her blood 30 minutes later and again 60 minutes (1 hour) later. In some cases, we might check hormone levels only at 60 minutes (1 hour).

To figure out the cause of adrenal insufficiency, sometimes, we need imaging studies of the pituitary or adrenal glands or genetic testing.

How do doctors treat adrenal insufficiency?

The good news is that cortisol and aldosterone can both be replaced by oral medications (medications taken by mouth). It is extremely important that your child takes these medications every day or he or she might develop adrenal crisis, a life-threatening condition.

To replace cortisol, your child’s doctor will prescribe a medication called a glucocorticoid. There are many choices of glucocorticoids including hydrocortisone (Cortef®), prednisone, and dexamethasone. If your child’s aldosterone levels are also low, your child’s doctor will prescribe fludrocortisone (Florinef®).

How should I treat my child if they are sick?

When your child is sick, injured or having surgery, he or she will need more replacement glucocorticoid than the amount you usually give. This means you should increase the dose of your child’s glucocorticoid.

When you increase the dose of your child’s glucocorticoid, it is called stress dosing. The doses are usually 2-3 times higher than your child’s regular dose. Your doctor will go over how you should increase your child’s dose.

You should increase the dose if your child has any of the following:

• Fever (over 100° F)
• Flu-like symptoms
• Any illness where he or she is too sick to go to school
• Injuries such as a broken bone
• Surgery in which he or she will need anesthesia (“going to sleep”)

If your child is vomiting or is too sick to take anything by mouth, he or she will need an injection of hydrocortisone (Solu-Cortef). It is extremely important to make sure that glucocorticoid levels in your child’s body are high enough to prevent serious illness. Your child’s endocrine team will teach you how to do the injections at home.

If your child is sick, it is never wrong to give stress doses of glucocorticoid or to give an injection. If you are unsure whether your child needs stress-dosing or an injection, please call our on-call pediatric endocrinologist, available 24 hours a day at 617-726-2909. We would rather hear from you than have you worry alone!

What is the long-term outlook for my child's adrenal insufficiency?

Your child will do very well as long as he or she is treated properly with the right medications and doses. Right now, there is no cure for adrenal insufficiency. It is a life-long disease.