What is adrenal insufficiency (AI) (Addison disease) treated in stressed or ill pediatric patients?

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

An important physiologic response to stress is an increase in adrenocorticotropic hormone (ACTH)-mediated cortisol production. Patients with adrenal insufficiency (AI) (Addison disease) are unable to mount this response, regardless of the reason, and they must be given stress doses of glucocorticoid.

When a febrile illness occurs or when a patient requires a surgical or stressful procedure, triple the glucocorticoid dosage. If a patient is vomiting or listless, administer parenteral glucocorticoid (hydrocortisone 50-100 mg/m2 given intramuscularly or intravenously or equivalent methylprednisolone 10-15 mg/m2 or dexamethasone 1-1.5 mg/m2). Repeat the dose every 6-8 hours until patient recovers, because hydrocortisone succinate has a short duration of action.

Injectable glucocorticoid must be provided to all patients with adrenal insufficiency. The patient and caretaker must be instructed in its administration, the indications for its use and the lifesaving importance of its administration.

Mineralocorticoid therapy does not need to be tripled during periods of illness or physical stress.

Glucocorticoid or mineralocorticoid replacement is not contraindicated when needed. This therapy is involved in few drug-drug interactions.


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