Atrium Health Navicent Children's Care Pediatric Endocrinology

Adrenal Gland Disease

Toddler girl brushing her teeth

Adrenal glands are small, triangular glands that are located on the top of each kidney. This gland is made up of the adrenal cortex, which is the outer part, and the adrenal medulla, which is the inside of the gland. The glands work with the pituitary gland and the hypothalamus, while also secreting hormones affecting the metabolism, body characteristics, and blood chemicals. Adrenal glands also produce hormones that help children deal with physical and emotional stress.

When adrenal glands are not able to produce cortisol and aldosterone, both important hormones to a child's body, the child is then known to have an adrenal gland disorder. This is often due to missing proteins in the body that cause or speed up chemical reactions called enzymes. This results in an enlarged set of adrenal glands because the hypothalamus is overstimulated, leading it to detect low levels of hormones. This leads to the hypothalamus stimulating the pituitary gland, which then stimulates the adrenal glands. When the adrenal glands are overstimulated, it may cause a child to overproduce androgens, leading to masculinization. Because of this, adrenal gland disorders in children require clinical care by a doctor.

Addison's Disease

Addison's disease is one adrenal gland disorder that results from an underactive adrenal gland. One in about 100,000 Americans is diagnosed with Addison's disease, with the onset being at any age.

The cause of Addison's disease is mostly unknown, although portions of them are caused secondarily by damage to the adrenal glands through other diseases such as cancer, autoimmune disease, infections, or other diseases. The use of corticosteroids can also slow down the processes of the adrenal glands, or the use of other medications. Sometimes, Addison's disease is genetically inherited by an X chromosome-linked trait from the mother's DNA.

Addison's disease may only produce symptoms when a child is experiencing stress, or more severe cases may present symptoms more often. The most common symptoms of Addison's disease are a loss of appetite/weight loss, dizziness, fatigue, weakness, diarrhea, nausea, vomiting, muscle aches, and a craving for salt. If left untreated, Addison's disease can lead to severe stomach pain, low blood pressure, shock, and kidney failure especially during stressful times in a child's life.

Treatment of Addison's disease often begins with medicating the child with additional corticosteroids, such as prednisone. Typically, the child then takes these steroids for life. Treatment for Addison's disease may also include a sodium and potassium supplement.

Cushing's Syndrome

Cushing's syndrome, alternatively, is an overactive adrenal disorder, occurring when the adrenal glands release too much cortisol into the body for extended periods of time. Without Addison's disease or Cushing's syndrome, the adrenal glands release the exact amount of cortisol that is necessary for human function.

Several factors may cause Cushing's syndrome to occur, including a pituitary tumor, a tumor on the adrenal gland, a tumor on any organ in the body, or the overuse of corticosteroids, such as Prednisone.

Cushing's syndrome may result in obesity, vertigo, acne, depression, emotional instability, fatigue, thin skin, and poor wound healing. Cushing's syndrome is more commonly found in females than males.

Adrenal over-activity in children is rare but possible. Only about ten percent of people who are diagnosed with adrenal over-activity are children. The main cause of Cushing's syndrome in children is adrenal tumors in younger children and pituitary adenomas in older children.

Compared to adults with Cushing's syndrome, children have fewer symptoms. Children are not likely to experience sleep disruption, muscle weakness or mental changes like adults are. In addition, while adults with Cushing's syndrome often have a change in their mental status, that negatively affects their job performance, the mental performance of children does not typically suffer.

Addison's disease and Cushing's syndrome are the two most common adrenal gland disorders in children. They are best caught early so any tumor or secondary cause of the disease can be rectified before further damage is done to the body.