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A Journal on Pediatrics, Neonatology, Adolescent Medicine,
Child and Adolescent Psychiatry

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Minerva Pediatrica 2014 December;66(6):517-32

language: English

Novel insights into adrenal insufficiency in childhood

Levy-Shraga Y. 1, 2 Pinhas-Hamiel O. 1, 2

1 Pediatric Endocrine and Diabetes Unit, Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Ramat‑Gan, Israel;
2 Sackler School of Medicine, Tel‑Aviv University, Tel Aviv, Israel


Adrenal insufficiency (AI) is a rare disease in childhood and adolescence that results from disruption in the hypothalamic-pituitary-adrenal axis. Pediatricians should be familiar with this entity since acute adrenal crisis is a life-threatening condition that requires immediate treatment. In the early stages of AI, the clinical manifestations may be subtle and non-specific; thus, they are frequently unrecognized. The main therapeutic approach in all forms of adrenal insufficiency is glucocorticoid replacement; the dose should be titrated appropriately to avoid under or overtreatment. Patient and family education is particularly important, to enable adjustment of dosage replacement therapy during stress and to prevent crisis. This article summarizes the current knowledge of AI and provides new insights on its management in children.

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