Adrenal Disorders in Children
What are adrenal disorders?
The adrenal glands are two small glands that sit above the kidneys. They produce several important hormones that help regulate growth, metabolism, blood pressure, the body's response to illness and stress, salt balance, and sexual development.
Adrenal disorders occur when the glands produce either too little or too much of these hormones. Although these conditions are relatively uncommon, they can have a significant impact on a child's health if left untreated. With early diagnosis and specialist care, most adrenal disorders can be managed successfully, allowing children to lead healthy, active lives.
Our paediatric endocrinologists have expertise in diagnosing and treating a wide range of adrenal conditions and work closely with families to provide personalised, long-term care.
What are the symptoms of adrenal disorders?
Symptoms vary depending on the underlying condition and whether the adrenal glands are producing too little or too much hormone.
Children with adrenal disorders may experience:
- Poor weight gain or weight loss
- Persistent tiredness
- Weakness
- Poor growth
- Low blood pressure
- Frequent vomiting
- Excessive thirst or dehydration
- Salt cravings
- Early pubic hair or signs of early puberty
- Excessive body hair
- Rapid weight gain
- A rounded face or stretch marks
- High blood pressure
Some babies with certain adrenal disorders become seriously unwell during the first few weeks of life, while others develop symptoms more gradually during childhood or adolescence.
Common adrenal disorders
Congenital Adrenal Hyperplasia (CAH)
Congenital adrenal hyperplasia (CAH) is an inherited condition present from birth. The adrenal glands are unable to produce certain hormones normally, leading to increased production of male-type hormones (androgens).
Depending on the type and severity of CAH, children may develop:
- Salt loss and dehydration in infancy
- Poor feeding
- Vomiting
- Early pubic hair
- Rapid growth during childhood
- Advanced bone age
- Early puberty
- Irregular periods in girls
CAH requires lifelong specialist management and regular monitoring.
Adrenal insufficiency (including Addison's disease)
Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol, and sometimes aldosterone.
Symptoms may include:
- Persistent fatigue
- Weight loss
- Poor appetite
- Abdominal pain
- Dizziness
- Low blood pressure
- Increased skin pigmentation (particularly in Addison's disease)
Children with adrenal insufficiency require lifelong hormone replacement and additional medication during illness or surgery.
Cushing syndrome
Cushing syndrome occurs when the body is exposed to excessive levels of cortisol.
Symptoms may include:
- Rapid weight gain, particularly around the face and abdomen
- Slowing of height growth despite weight gain
- Purple stretch marks
- Muscle weakness
- High blood pressure
- Mood changes
- Acne
Although rare in children, Cushing syndrome requires specialist assessment and treatment.
When should I seek medical advice?
You should consider arranging an assessment if your child has:
- Persistent tiredness or weakness
- Poor growth
- Unexplained weight loss or rapid weight gain
- Early signs of puberty
- Recurrent vomiting without an obvious cause
- Low blood pressure or frequent dizziness
- Abnormal hormone blood test results
- A family history of inherited adrenal disorders
Urgent medical attention is required if a child with known adrenal insufficiency becomes severely unwell, collapses or is unable to keep their medication down, as this may indicate an adrenal crisis, which is a medical emergency.
How are adrenal disorders diagnosed?
Diagnosis begins with a detailed discussion about your child's symptoms, growth and medical history, followed by a physical examination.
Investigations may include:
- Blood tests to measure hormone levels
- Urine tests
- ACTH stimulation testing
- Genetic testing (where appropriate)
- Imaging of the adrenal glands or pituitary gland in selected cases
Your endocrinologist will recommend investigations based on your child's individual symptoms and suspected diagnosis.
What treatment is available?
Treatment depends on the specific adrenal disorder.
Options may include:
- Hormone replacement therapy
- Medication to control hormone production
- Regular monitoring of growth and development
- Dietary advice, including salt supplementation where appropriate
- Surgery in selected cases
- Education on managing illness and emergency medication for children with adrenal insufficiency
Children with chronic adrenal disorders usually require regular follow-up to ensure treatment remains appropriate as they grow.
Long-term outlook
Most children with adrenal disorders do very well when diagnosed early and managed by a specialist paediatric endocrinology team.
Regular monitoring, medication adjustments and ongoing support help children achieve normal growth, development and participation in school, sport and everyday life.
Families are provided with education about recognising symptoms, managing illness and knowing when to seek urgent medical attention.