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Adrenal crisis prevention

  • An adrenal crisis happens during times of physical stress, when the body cannot make enough of the adrenal hormones cortisol and aldosterone. Hormones are chemicals made by the body to do certain jobs including to control blood sugar levels, blood pressure, blood volume and the amount of salt in the blood. Many adrenal crises can be prevented. If not treated, adrenal crisis can be life threatening.

    Children who have congenital adrenal hyperplasia (CAH), hypopituitarism or are on long term steroid medicine may sometimes have 'an adrenal crisis'. On rare occasions children without these conditions may also experience it.

    Causes

    • Vomiting
    • diarrhoea
    • high temperatures (fever)
    • injuries including broken bones
    • cuts requiring stitching
    • surgery

    All of the above are physical stresses that can cause an adrenal crisis in children with certain conditions, or in children on long term steroid medicine.

    Signs and symptoms

    Children with adrenal crisis may:

    • feel weak
    • feel very tired
    • have low blood pressure
    • have low blood sugar
    • begin vomiting
    • feel nauseous

    Treatment to prevent adrenal crisis

    Adrenal crisis can often be prevented by early treatment - please make sure you discuss the information below with your child's endocrinologist so that you understand it well. If your child has congenital adrenal hyperplasia (CAH), hypopituitarism or is on long term steroid medicine you need to watch out for the following common illnesses that may lead to an adrenal crisis.

    Vomiting

    One or two vomits

    • If your child has vomited once or twice, give three times their normal dose of cortisone, prednisolone or hydrocortisone. They need to drink small amounts of sugary drinks often. If your child is on Florinef, continue giving the normal dose of this medicine.
    • If they do notvomit again then keep giving them sugary drinks. Give the next dose of steroids at the normal time and at the normal dose.

    More than two vomits

    • If your child does vomit again or becomes sleepy or drowsy, then they must see a family doctor or come to the Emergency Department as soon as possible and have an injection of hydrocortisone. If this happens your child will need to be monitored for several hours after the injection.

    Adrenal Crisis flowchart KHI RCH


    Diarrhoea

    If your child has any diarrhoea they must see your family doctor (GP) or go to a hospital emergency department to get an injection of hydrocortisone. Your child will need to be monitored for several hours after this injection.

    Unwell with fever

    Give three times the normal dose of cortisone, prednisolone or hydrocortisone. They must see your family doctor (GP) or an emergency department to be assessed and will need to keep taking three times the usual dose of steroids until they are well again. If your child is on Florinef, continue giving the normal dose of this medicine.

    Injury (broken bone or cut)

    Your child must see your family doctor (GP) or an emergency department to get an injection of hydrocortisone. They will need to be monitored for several hours after this injection.

    Surgery or anesthetic

    An injection of hydrocortisone is given to your child before the operation and either an injection or increased does of tablets is given after the operation. Please make sure you always tell medical staff if your child has congenital adrenal hyperplasia (CAH), hypopituitarism or is on long term steroid medicine. 

    Follow-up

    Routine follow up with your endocrine doctor as usual or as directed by the family doctor.

    Key points to remember

    • An adrenal crisis is more common in children with CAH, hypothyroidism or on long term steroid medicines.
    • Adrenal crisis happens during times of physical stress, when the body can not make enough of the adrenal hormones.
    • Adrenal crisis can often be prevented by early treatment as above. If not treated it can be life threatening.
    • Please make sure you understand the information in this factsheet before your child becomes unwell.  Speak with the endocrine doctor if you have any questions.
    • If you are ever worried or unsure, see a doctor.

    More information

    • Your family doctor (GP)
    • Your child's endocrinologist
    • Royal Children's Hospital
      T:(03) 9345 5522
      As for the Endocrinology Department or the endocrinologist who is on-call
    • Congenital Adrenal Hyperplasia support groups Australia Incorporated website  www.vicnet.net.au/~cahsga/

    Individual information

    Your child's endocrinologist name:

    Family doctor name:

    Tel:

     

     

    Developed with the RCH Dept of Endocrinology. First published Nov 2006. Updated November 2010

Disclaimer
This is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. The Royal Children's Hospital accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.
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