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Adrenal Insufficiency in Premature Infants

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What is Adrenal Insufficiency?

Adrenal insufficiency is caused by under-active adrenal glands. The adrenal glands located on top of each kidney are unable to produce enough hormones. These hormones include cortisol and aldosterone. They help keep blood pressure and blood sugar normal, as well as maintain salt and water balance. These hormones are especially important when the body needs to fight an infection or recover from an injury or surgery. Adrenal insufficiency can be life-threatening if not properly managed.

Due to your baby’s premature birth, the adrenal glands were not mature enough to make enough cortisol. As your baby grows and the adrenal glands mature, your baby will most likely be able to make enough cortisol on his/her own.

Testing for Adrenal Insufficiency

A stimulation test has been done to determine if the adrenal glands are producing enough hormones. With this test, a man-made hormone called ACTH was given to your baby. Later, blood was drawn at certain times to measure the amount of cortisol present. The test showed that your baby needs to continue taking hydrocortisone.

Signs and Symptoms of Adrenal Insufficiency:

  • Cold, clammy skin
  • Fast heart rate and breathing
  • Weakness
  • Confusion
  • Irritability
  • Poor feeding
  • Dehydration: dry toungue, increased thirst, fewer wet diapers, dark circles under the eyes

Babies with adrenal insufficiency may also have low blood pressure, low blood sugar and salt and water imbalance. These symptoms can be so severe that emergency treatment may be necessary. If not treated properly, a life-threatening condition may occur.

Life-Threatening Emergency, Treat Quickly:

Call 911 and give the cortisol injection immediately if your baby “looks bad”:

  • is pale, sweaty or breathing fast
  • seems weak or lethargic
  • is unable to respond normally or becomes unconscious
  • is having convulsions or seizures
  • or has a serious injury

Treatment for adrenal insufficiency:

Hormone replacement is the treatment for adrenal insufficiency. A form of cortisol, called hydrocortisone will be given by mouth to your baby. If your baby vomits or is unable to take the cortisol by mouth, we will need to give a shot of hydrocortisone.

Stress dosing:
Any illness or other physical stress may affect your baby’s health. Usually during times of illness or stress the body makes larger amounts of cortisol to heal. Your baby does not make enough cortisol to help the body recover. When your baby is sick or has surgery he/she will need to be given extra cortisol, called the “stress dose”. Examples of physical stress/illness requiring stress dosing:

  • A fever higher than 101 F
  • Ear infection
  • Pneumonia
  • Vomiting or diarrhea
  • Surgery
  • Any serious injury
  • Stress dosing should also be given when your baby is receiving most immunizations. Your baby should NOT receive stress dosing when receiving the varicella vaccine (chickenpox).

If you are unsure about increasing the dose, give the stress dose and then check with your doctor about continuing the dose. You should continue the stress dose for 24 hours after the fever is gone and your baby seems to be feeling better. Your baby may need to receive the stress doses by shots if the illness includes vomiting or diarrhea.

In addition to the larger dose of hydrocortisone, your baby should drink extra fluids to prevent dehydration. You should contact your doctor immediately if your baby is experiencing vomiting or severe diarrhea.

Inform all your baby’s doctors about all medications you give your baby.

You should always give any doctor who treats your baby a list of all his/her medications. If your baby is going to have a surgical procedure, be sure and notify the endocrinologist. He/she will tell you how much extra hydrocortisone your baby should get for stress dosing due to the surgery. Other medication doses will be changed as needed. You will talk about these medication dose changes with the surgeon and anesthesiologist when you meet with them to talk about your baby’s surgery.

Future Lab Test

Your baby will be scheduled for another ACTH stimulation test in 4 -6 weeks. The test will let us know if your baby is making enough cortisol. An IV will be inserted and blood tests will be done at certain times. The test takes less than 2 hours. You should NOT give your baby hydrocortisone the night before or morning of the test. Bring the hydrocortisone medicine to the hospital so you can give your baby the medicine when the test is over.

Your baby’s ACTH stimulation test is on ____________________________________________.

Your endocrinologist is:
_____ Reuben Rohn, MD
_____ Marta Satin-Smith, MD
_____ Eric Gyuricsko, MD

The numbers to call are:

  • MD office: 757-668-7237 (non-urgent calls)
  • Nurse line: 757-668-8571 (non-urgent calls)
  • Emergency calls: 866-883-9886 (nights, weekends & ALL EMERGENCIES)

Do not be afraid to call if you are unsure about what to do. We would rather you call us with your concerns than risk your baby’s health by not calling.


Disclaimer:This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 06/2008

(757) 668-7000