Adrenal crisis in infants and young children with adrenal insufficiency: Management and prevention

Background

Despite the optimization of replacement therapy, adrenal crises still represent life-threatening emergencies in many children with adrenal insufficiency.

Objective

We summarized current standards of clinical practice for adrenal crisis and investigated the prevalence of suspected/incipient adrenal crisis, in relation to different treatment modalities, in a group of children with adrenal insufficiency.

Results

Fifty-one children were investigated. Forty-one patients (32 patients <4 yrs and 9 patients >4 yrs) used quartered non-diluted 10 mg tablets. Two patients <4 yrs used a micronized weighted formulation obtained from 10 mg tablets. Two patients <4 yrs used a liquid formulation. Six patients >4 yrs used crushed non-diluted 10 mg tablets. The overall number of episodes of adrenal crisis was 7.3/patient/yr in patients <4yrs and 4.9/patient/yr in patients >4 yrs. The mean number of hospital admissions was 0.5/patient/yr in children <4 yrs and 0.53/patient/yr in children >4 yrs. There was a wide variability in the individual number of events reported. Both children on therapy with a micronized weighted formulation reported no episode of suspected adrenal crisis during the 6-month observation period.

Conclusion

Parental education on oral stress dosing and switching to parenteral hydrocortisone when necessary are the essential approaches to prevent adrenal crisis in children.

Overview publication

TitleAdrenal crisis in infants and young children with adrenal insufficiency: Management and prevention
DateFebruary 13th, 2023
Issue nameFrontiers in Endocrinology
Issue numberv14
DOI10.3389/fendo.2023.1133376
AuthorsBizzarri C, Capalbo D, Wasniewska MG, Baronio F, Grandone A & Cappa M
MTGsMTG1
Read Read publication