Secondary adrenal insufficiency in children is rare but causes considerable morbidity and, sadly, can result in death. Causes are developmental, such as septo-optic dysplasia, or as a result of treatment of brain/pituitary tumours. A proportion of patients also have learning disabilities.

Rushworth and colleagues describe 47 patients (one with hypothalamic-pituitary-adrenal axis suppression from exogenous steroid). Co-existent cranial diabetes insipidus (CDI) was found in 46% of patients. The cohort had 168 admissions related to adrenal insufficiency/crisis, commoner in those with concomitant CDI. It was found that 60% had prodromal symptoms, 42% of admissions were related to infections, 11.9% had hyponatraemia, 8.9% had hypernatraemia, 10.7% had low blood glucose (<3.5mmol/l). Alarmingly, 20% had a seizure.

This cohort shows how important it is to support patients, their families, and non-endocrinology healthcare professionals with education about sick day rules and adrenal insufficiency. It also shows why, during transition to adult services, patients and their families may have a lot of anxiety about changing healthcare teams. In particular, they may be concerned about moving away from a CNS team who have given a lot of support during the childhood years. We need to ensure we have adult services that ‘catch’ these vulnerable patients.

Read the full article in Clinical Endocrinology 94 913−919