Adrenal Insufficiency: Pediatric Fellow of Endocrine, Diabetes, How - PowerPoint PPT Presentation

Patrick Rizzuto, MD Adrenal Insufficiency: Pediatric Fellow of Endocrine, Diabetes, How to deal with urgencies/ and Metabolism emergencies at school PGY4

Adapted from previous presentation given by Emily R. Miller, DO

Objectives By the end of this lecture, attendees should be able to…. 1. Recognize the role of adrenal glands in maintaining health 2. Identify causes of adrenal insufficiency 3. Recognize and manage an acute crisis in adrenal insufficiency

Adrenal Glands • Sit on kidneys (“ad” ‐ ”renal”) • Two major zones • Responsible for production of many hormones, including cortisol and aldosterone

Cortisol • Various roles in body  Blood sugar  Blood pressure  Increase energy  Promote appetite  Control inflammation

ACTH Pituitary Gland Cortisol Adrenal Glands

“Central” Adrenal Insufficiency Pituitary Gland ACTH Adrenal Glands Cortisol

“Primary” Adrenal Insufficiency Pituitary Gland Cortisol Adrenal Glands

Causes of Adrenal Insufficiency Primary Causes: Central Causes: • Congenital Adrenal • Hypopituitarism Hyperplasia • Autoimmune • Addison’s Disease inflammation • Medications • Medications • Hemorrhage • Post ‐ radiation therapy • Surgical Removal • Surgery

Basic Management • Replace the steroids! • Physiologic replacement • “Stress doses”

What is an “Adrenal Crisis”? • “Stress hormone” • Body needs different amount of cortisol at different times • You’re stressed? Need stress hormone!

Possible Causes • Withdrawal • Illness • Injury • Other significant stress (can be mental)

What symptoms indicate there is a problem? • Vomiting • Lethargy • Fever • Weakness • Fainting • Dehydration • Confusion, LoC

What should I do if my student is ill? Ask: “Is the student awake and able to swallow?” Yes No 1. Contact parent 1. Give IM hydrocortisone (Solu ‐ cortef R ) 2. Give oral stress dosing as outlined by 2. Call 911 family/physician 3. Contact family *EMS often cannot give Solu ‐ Cortef!

How do I inject hydrocortisone if needed? 1. Wash hands and remove plastic cap 2. Push down on plastic top to mix the liquid and powder in the lower part of the vial 3. Gently shake the solution until it is clear

How do I inject hydrocortisone if needed? 4. Clean rubber stopper with alcohol 5. Place needle through center plunger until tip is visible in bottle 6. Hold vial upside ‐ down and draw hydrocortisone into the syringe 7. Inject into the thigh muscle

What if I still don’t know if I should escalate care? • When in doubt, treat – Unnecessary hydrocortisone won’t hurt – Not giving stress dose when needed could result in shock – can be fatal • Talk with parents/guardians • Talk with on ‐ call endocrinologist: (804)828 ‐ 0951

Questions? Picture from:www.iheartguts.com