Disorder  of Adrenal Function:

The disorders of  adrenal function may lead  to acute and chronic  .adrenocortical insufficiency. Let  us briefly  describe each  one as follows. 

Acute Adrenocortical Insufficiency:

This  is a rare  disorder and may  result from  variety  of  causes  such  as haemorrhage  in glands from trauma due  to  difficult labour, meningococcal infections and or  abrupt withdrawal  of  exogenous sources  of  cortisone or failure to increase exogenous supplies  during stress or congenital  adreno genital hyperplasia. Management includes replacement of  cortisol,  body fluids  to correct dehydration  and hypovolemia administration of glucose  to correct hypoglycemia and specific antibiotic  therapy. Blood transfusion  is given  if  haemorrhage  is severe. 

Chronic Adrenocortical  Insufficiency (Addison's Disease):

This disorder rarely occurs in children. It  is caused  by  destructive lesion  of  the adrenal glands or a neoplasm, or  it  is  idiopathic. The child may present with neurologic symptoms such as muscular weakness, mental fatigue, irritability pigmentry changes,  palinar creases, hyperpigmentation over pressure points, dehydration, anorexia weight loss, headache, hunger, sweating  and weakness etc. Therapeutic  treatment includes replacement of cotisol and aldosterone. 

Cushing Syndrome:

Cushings syndrome  is uncommon  in children.  It  is a characteristic group  of manifestations caused  by  excessive circulating  free cortisol. (Fig.  5.2).  It may occur  due  to one or more of the following causes: 

Pituitary with adrenal hyperplasia, usually attributed  to an  excess of ACTH  

Adrenal with hypersecretion of  glucocorticoids, generally the result of adrenocortical neoplasms 

Ectopic with autonomous secretion  of ACTH, most often caused  by extrapituitary neoplasms Iatrogenic,  frequently the result of administration of  large amounts of exogenous coricosterioids Food  dependent,  inappropriate sensitivity  of  adrenal glands to normal postprandial increases in  secretion of  gastric inhibitory polypeptide Therapeutic management involves bilateral adrenalectomy and post operative replacement of the cortical hormgnes.