adrenal in children

Overview

The adrenal glands are two small, triangle-shaped glands that sit on top of each kidney. They make hormones that help the body manage stress, blood pressure, blood sugar, and the balance of salt and water. In children, adrenal gland disorders can affect growth, development, and overall health. These conditions are treatable, and with the right care, most children can live full and active lives.

Adrenal gland disorders are not common in children. Some forms, like congenital adrenal hyperplasia, are present from birth and are identified through newborn screening in many countries. Other types, such as adrenal insufficiency, are even rarer in childhood.

Adrenal disorders can affect newborns, young children, and teenagers. They can occur in any child, but some types have a genetic link, meaning they run in families. Both boys and girls can be affected, though certain conditions may cause different symptoms in each sex.

Symptoms

Common symptoms

• Feeling very tired or weak
• Unexplained weight loss
• Low blood pressure
• Increased cravings for salty foods
• Darkening of the skin, especially on scars, skin folds, or gums
• Nausea, vomiting, or poor appetite

Symptoms in children

• Poor feeding and slow weight gain in babies
• Dehydration and vomiting
• Slow growth or short stature
• Ambiguous genitalia in some newborn girls
• Early signs of puberty
• Excessive thirst and urination

Symptoms in older adults

• Although this article focuses on children, adrenal disorders can also affect older adults. In older adults, symptoms may include gradually worsening fatigue, muscle weakness, weight loss, low blood pressure, and darkened skin.

Causes

Main causes

• Congenital adrenal hyperplasia (CAH), an inherited condition that affects how the adrenal glands make hormones
• Autoimmune damage, where the body's immune system mistakenly attacks the adrenal glands
• Infections that can damage the adrenal glands
• Tumors or growths on the adrenal glands, though rare in children
• Problems with the pituitary gland, which sends signals to the adrenal glands

Risk factors

• A family history of adrenal disorders or autoimmune diseases
• A child with another autoimmune condition, such as thyroid disease
• Recent surgery or injury to the adrenal glands
• Certain long-term medicines that can affect adrenal function, as discussed with your doctor

When to see a doctor

See a doctor urgently if:

• Seek urgent medical care if your child has symptoms of an adrenal crisis, such as severe vomiting, extreme weakness, fainting, or seizures.
• Contact your child's doctor right away if they cannot keep down their medicines or fluids due to illness.

Book a routine appointment if:

• Make an appointment if your child has ongoing tiredness, poor appetite, weight loss, or slower growth than expected.
• Talk to your doctor if you notice any unusual skin darkening or persistent salt cravings.
• If your child has been diagnosed with an adrenal condition, keep all scheduled appointments for hormone checks.

Diagnosis

A doctor will first take a detailed medical history and examine your child. Some adrenal conditions are found through newborn screening. If a problem is suspected, the doctor will likely order blood and urine tests to check hormone levels, blood sugar, and electrolytes (salts in the blood).

Tests that may be done

• Blood tests to measure cortisol, aldosterone, and other hormone levels
• Urine tests to check how hormones are being processed
• ACTH stimulation test, which shows how well the adrenal glands respond to a signal from the brain
• Genetic testing to look for inherited causes such as congenital adrenal hyperplasia
• Imaging scans (like ultrasound, CT, or MRI) to check the size and shape of the adrenal glands

What to expect at your appointment

Your child may need to have blood drawn, which can be upsetting. The doctor or nurse will explain each step and help your child feel comfortable. You may be referred to a pediatric endocrinologist, a doctor who specializes in hormone problems in children. Diagnosis often takes a few appointments, and it is important to share any changes in symptoms with the care team.

Treatment

The main goal of treatment is to replace the hormones the adrenal glands are not making enough of, and to keep hormone levels steady. With the right treatment plan, children with adrenal disorders can grow and develop normally. Treatment is lifelong and requires careful monitoring, especially during illness or stress.

Self-care at home

• Give your child their hormone replacement medicines exactly as prescribed, every day.
• Follow a 'sick day' plan from your doctor for extra medicine when your child has a fever, vomiting, or severe stress.
• Have your child wear a medical alert bracelet or necklace that describes their adrenal condition.
• Carry a letter from your doctor explaining the condition and the medicines your child needs.
• Teach your child (as they get older) to understand their condition and speak up about how they feel.

Medical treatments

Treatment involves daily hormone replacement medicines to replace the missing cortisol and aldosterone. Doctors also prescribe medications to replace other hormones if needed, such as growth hormone for delayed growth or medicines to manage early puberty. The types and doses of medicines are tailored to each child's needs and updated as the child grows. Regular blood tests and check-ups help the doctor adjust the plan.

When is surgery considered?

In some children, especially those with congenital adrenal hyperplasia, surgery may be considered for the genitals if there is ambiguity (when the outside genitals do not look typically male or female). This type of surgery is usually not urgent and is often discussed in detail with the family and a specialist team. Surgery may also be needed if a tumor on the adrenal glands is found.

Living with this condition

Living with an adrenal disorder means making a daily routine of medicines and check-ups. It is important to ensure your child's school knows about the condition and has an emergency plan. As your child grows, teach them to take responsibility for their own health and to recognize warning signs.

Lifestyle tips

• Build a steady daily routine that includes medicine at the same times.
• Ensure your child has regular sleep and manages stress.
• Plan for extra rest and extra medicine during illness, injury, or emotional stress.
• Keep an emergency kit at home and travel, as recommended by your doctor.

Diet and exercise

Most children with adrenal disorders can eat a normal, healthy diet. Some children need extra salt, especially in hot weather or after exercise, so talk to your doctor about salt needs. Exercise and sports are usually safe and encouraged, but your child may need to adjust fluid and salt intake and have an extra dose of medicine before heavy activity, as directed by your doctor.

Mental health and emotional wellbeing

Living with a chronic disorder can be tough for a child. They may feel different from friends or worry about their condition. Watch for signs of anxiety, low mood, or withdrawal. Talk openly and support them. If your child shows signs of depression or thoughts of self-harm, seek help immediately and call a crisis line or your local emergency number.

Prevention

Some adrenal disorders can't be prevented because they are inherited. However, early detection through newborn screening and prompt treatment can prevent serious complications and help your child lead a healthy life.

Vaccines

Make sure your child receives all recommended vaccinations. Protecting against illnesses like flu and infections is important because a high fever or severe infection can trigger an adrenal crisis in children with adrenal conditions.

Screening programmes

Many countries screen newborns for congenital adrenal hyperplasia using a simple heel-prick blood test. If your child is older and shows symptoms, blood and urine tests can be done at any time.

Complications

If left untreated

• Adrenal crisis, a life-threatening emergency that causes very low blood pressure, low blood sugar, and shock
• Poor growth and delayed development
• Learning difficulties and problems with concentration
• Fertility problems later in life for some inherited conditions
• Emotional and behavioral difficulties due to hormone imbalances

Long-term outlook

The outlook for children with adrenal disorders is very positive when diagnosed early and treated carefully. With regular medicine, monitoring, and a clear emergency plan, most children can participate in normal activities, enjoy good health, and grow into healthy adults.

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