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Addison Disease in Children
WHAT YOU NEED TO KNOW:
What do I need to know about Addison disease?
Addison disease is a condition that causes low levels of aldosterone and cortisol. These hormones are made by your child's adrenal glands. Cortisol helps your child's body handle stress. Aldosterone helps your child's body balance salt, potassium, fluid. Addison disease may appear soon after your child is born, or when he or she reaches adolescence.
What causes Addison disease?
A family member with Addison disease may increase your child's risk for this condition. Addison disease is often caused by damage to the adrenal glands. It may also be caused by a problem in the pituitary gland. The pituitary gland makes hormones that control how the adrenal glands work. The following can increase your child's risk for Addison disease:
- A disease that attacks your child's immune system
- A genetic disorder that causes problems with your child's adrenal gland or pituitary gland
- Infections such as tuberculosis (TB), a fungal infection, or HIV
- Bleeding in your child's adrenal gland caused by trauma
- Certain medicines, such as antifungals
- Certain types of cancer, or radiation to your child's adrenal gland
What are the signs and symptoms of Addison disease?
Signs and symptoms may be present at birth or show up slowly over months or years. Your child may have any of the following:
- Feeling dizzy, weak, and tired
- Loss of appetite, or weight loss
- Nausea, vomiting, or diarrhea
- Muscle, joint, stomach, or back pain
- A craving for salty foods
- An increased sensitivity to cold temperatures, or sweating more than usual
- Darkening of the skin on the lips, palms, nipples, genital area, and inside the mouth
- Depression or trouble thinking clearly
- Adolescent females may stop having a monthly period
How is Addison disease diagnosed?
Your child's healthcare provider will examine your child and ask about his or her symptoms. Tell the provider if your child has any other health conditions or a family history of Addison disease. Your child may need any of the following:
- Blood and urine tests may be used to measure your child's hormone levels. Your child's blood may be collected after a hormone is injected. The hormone causes the adrenal glands to make cortisol and aldosterone. Blood tests also check your child's blood sugar levels, electrolyte levels, blood cell levels, and kidney function. Your child's pituitary and thyroid gland hormone levels may also be measured.
- An x-ray, CT, or MRI may be done to check the size of your child's adrenal gland. These tests also check for problems that may cause Addison disease. Your child may be given contrast liquid to help the area show up better in pictures. Tell a healthcare provider if your child has ever had an allergic reaction to contrast liquid. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell a healthcare provider if your child has any metal in or on his or her body.
- A biopsy is used to take a sample of your child's adrenal gland. The sample can be checked for signs of Addison disease.
How is Addison disease treated?
Causes of Addison disease will be treated. Your child may also need any of the following:
- Steroid medicine is given to increase your child's cortisol level. This medicine helps your child's body handle stress and prevent an adrenal crisis. Steroid medicine will also help decrease your child's symptoms such as weakness and fatigue. Always carry extra steroid medicine for your child. Do not skip a dose of your child's medicine. Do not stop giving your child this medicine without talking to his or her healthcare provider. Your child may have an adrenal crisis if he or she misses a dose of medicine or stops taking medicine.
- Aldosterone supplements may be given to help your child's body balance salt and fluid. This can help prevent dehydration and low sodium (salt) levels.
- Sodium supplements help increase the amount of salt in your child's blood. Your child may need to take salt supplements every day. Instead, he or she may need to take salt supplements before exercise, in hot weather, or when he or she has diarrhea or vomiting.
What do I need to know about an adrenal crisis?
An adrenal crisis happens when your child's cortisol and aldosterone levels suddenly drop. This may lead to low blood pressure, dehydration, and low blood sugar. An adrenal crisis is life-threatening and needs immediate treatment in a hospital. Your child will be given steroids and glucose (sugar). He or she may be given sodium (salt) and medicine to increase his or her blood pressure. Your child may also need IV fluids to treat dehydration. An adrenal crisis can happen if your child suddenly stops taking his or her medicine. It can also happen when your child's body is under more stress than usual. This may happen during surgery, an illness, or trauma.
What can I do to care for my child?
- Manage your child's condition during sick days. Sick days may include days your child has a cold, diarrhea, or is vomiting. Your child's body will need more steroid medicine when he or she is sick to prevent an adrenal crisis. Increase your child's steroid dose as directed when he or she is sick. You may need to inject steroid medicine if he or she is vomiting and cannot swallow medicine. Your child's healthcare provider will show you how to inject your child's medicine. Ask if your child needs to drink an oral rehydration solution (ORS) during an illness. An ORS has the right amounts of water, salts, and sugar that your child needs to replace lost body fluids.
- Check your child's blood pressure and blood sugar levels as directed. Write down your child's blood pressure readings and blood sugar levels. Bring these numbers to your child's follow-up appointments. Ask your child's healthcare provider for more information about how to check his or her blood pressure and blood sugar levels.
- Have your child wear medical alert jewelry or carry a card that says he or she has Addison disease. Ask your child's healthcare provider where to get these items.
- Ask about vaccines. Vaccines can help prevent illnesses that may trigger an adrenal crisis. Ask your child's healthcare provider if your child should get a flu or pneumonia vaccine, and when to get the vaccine.
- Give directions to your child's school and caregivers. Make sure your child's teachers and caregivers know he or has Addison disease. Provide written instructions about what to do if your child has symptoms of an adrenal crisis. Give extra doses of steroid medicine to your child's caregivers or school nurse.
Call your local emergency number (911 in the US) if:
- Your child has a seizure.
- Your child loses consciousness or cannot be woken.
- Your child has shortness of breath or trouble breathing.
When should I seek immediate care?
Your child has any of the following early signs or symptoms of an adrenal crisis:
- Your child's heart is beating faster than usual.
- Your child has a headache, hallucinations, or feels confused.
- Your child has muscle weakness or muscle cramps.
- You child has severe pain in his or her stomach, back, or legs.
- Your child has numbness and tingling in his or her fingers or around his or her mouth.
- Your child has trouble staying awake.
- Your child urinates less than usual or stops urinating.
- Your child has fewer wet diapers than usual.
When should I call my child's doctor or endocrinologist?
- Your child has a fever.
- Your child has symptoms of a cold or the flu such as a cough or congestion.
- Your child has 2 or episodes of diarrhea.
- Your child has nausea or stomach pain, or is vomiting.
- Your child has so much vomiting that or she cannot drink any liquids.
- You sweats more than usual.
- You have questions or concerns about your child's condition or care.
Care AgreementYou have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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