CHRONIC ADRENOCORTICAL INSUFFICIENCY
- Rare in children
Causes:
- Destruction lession of adrenal gland or neoplasms
- Idiopathic.
Clinical Manifestations:-
>Neurological symptom
- Muscular weakness
- Mental fatigue
- Irritability
- Apathy
- Negativism
- Increased sleeping
- Listlessness
>Pigmentary Changes:-
- Hyperpigmentation over
- Less frequently vitiligo (loss of pigmentation)
>Gastrointestinal symptoms:-
- Dehydration
- Anorexia
- Weight loss
>Circulatory symptoms:-
- Hypotension
- Small heart size
- Dizziness
- Syncope
- Hypoglycemia
- Headache
- Hunger
- Weakness
- Trembling
- Sweating
Management:-
- Replacement of glucocorticoid and mineralocorticoids
- Oral supplements of cortisol or monthly injections of deoxycorticisterone acetate pellets subcutaneously every 9-12 months
- Correction of shock by fluid boluses
- Hydrocortisone at a dose of 50 mg/m2 followed by 100 mg/m2/ day
- Frequent monitoring of hemodynamic parameters,urine output and serum electrolytes
- Hemodynamically stable-hydrocortisone can be tapered to physiological dose 10 mg /m2/ day.
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