Diagnosis of adrenal insufficiency in children
- Patricia A Donohoue, MD
Patricia A Donohoue, MD
- Professor of Pediatrics
- Medical College of Wisconsin
Adrenal insufficiency is defined by the impaired synthesis and release of adrenocortical hormones. It is classified based upon whether the etiology is primary, secondary, or tertiary:
●Primary adrenal insufficiency, also known as Addison's disease, results from disease intrinsic to the adrenal cortex (table 1).
●Secondary adrenal insufficiency is caused by either impaired release or effect of adrenocorticotropic hormone (ACTH) from the pituitary gland (table 2).
●Tertiary adrenal insufficiency results from the impaired release or effect of corticotropin releasing factor (CRH) from the hypothalamus (table 3).
In addition, there are disorders of end-organ unresponsiveness to adrenocortical hormones that present in a similar manner as diseases caused by adrenocortical hormone deficiencies. These include glucocorticoid (cortisol) resistance and aldosterone resistance. (See "Causes and clinical manifestations of primary adrenal insufficiency in children", section on 'End-organ unresponsiveness'.)
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- DIAGNOSTIC APPROACH
- Confirming adrenal insufficiency
- Primary versus secondary and tertiary adrenal insufficiency
- Evaluation for cause
- - Primary adrenal insufficiency
- - Secondary and tertiary adrenal insufficiency
- TESTS OF ADRENOCORTICAL FUNCTION
- Static tests
- - Cortisol
- - ACTH
- - Mineralocorticoid status
- - Adrenal androgens
- - Urinary steroids
- Dynamic tests
- - ACTH stimulation
- Short intravenous ACTH test
- Prolonged ACTH test
- - Tests of ACTH secretory ability
- SUMMARY AND RECOMMENDATIONS