How is adrenal crisis treated in pediatric adrenal insufficiency (Addison disease)?

Updated: Dec 07, 2018
  • Author: Kimberly Tafuri, DO; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Patients with suspected adrenal crisis should undergo immediate treatment with a parenteral injection of 100 mg (50 mg/m2 for young children) hydrocortisone, after which, appropriate fluid resuscitation should be administered, as well as 200 mg (50-100 mg/m2 for children) of hydrocortisone/24 hours (by way of continuous IV therapy or 6-hourly injection). If hydrocortisone is unavailable, prednisolone may be used. Dexamethasone is least-preferred, as its onset of action is slow. [44]

After results for the patient's electrolyte, blood sugar, cortisol, and adrenocorticotropic hormone (ACTH) concentrations are obtained, administer glucocorticoids if adrenal insufficiency is suspected. If a cosyntropin stimulation test is chosen, a single dose of dexamethasone may be administered without interfering with the measurement of the cortisol response to cosyntropin.

No surgical management is needed in most cases.


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