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Management of Adrenal Crisis - How Should Glucocorticoids be Administered?

Adrenal insufficiency in childhood is more usually due to adrenocorticotropic hormone (ACTH) insufficiency than primary adrenal failure. Congenital adrenal hyperplasia is the commonest cause of adrenal insufficiency, although Cortisol secretion is usually insufficiency rather than deficiency. Of course, children with primary adrenal failure may have concominant mineralocorticoid insufficiency, as well as glucocorticoid insufficiency. Hypoglycaemia, hypotension and hyponatraemia are common accompaniments of hypocortisolaemia. Hypoglycaemia is more likely in children with contemporaneous GH deficiency. Fluid and salt loss associated with the common intercurrent infection of gastroenteritis may exaggerate concomitant hypotension and hyponatraemia from adrenal failure.