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Published on: September 15, 2017
Adrenal insufficiency management in the pediatric emergency setting and risk factors for adrenal crisis development
Enrica Abrigo1,2, Jessica Munarin3,4, Claudia Bondone1,5
1Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Piazza Polonia 94, Turin, 10126, Italy.
Insights
Adrenal crisis (AC) in children with adrenal insufficiency (AI) requires prompt recognition in the Emergency Department (ED). Educating families and improving ED awareness of early AC signs are crucial for better outcomes.
Area of Science:
- Pediatric Endocrinology
- Emergency Medicine
- Clinical Research
Background:
- Adrenal insufficiency (AI) can lead to life-threatening adrenal crisis (AC).
- Timely recognition and management of AC in the Emergency Department (ED) are critical.
- This study characterizes AC presentation in pediatric AI patients to improve ED care.
Purpose of the Study:
- To report clinical and biochemical characteristics of AC presentation in pediatric AI patients.
- To improve timely recognition and management of AC in the ED.
- To identify factors associated with AC development.
Main Methods:
- Retrospective, observational study at a single pediatric center.
- Inclusion of pediatric patients with primary AI (PAI) and central AI (CAI).
- Analysis of patient demographics, admission causes, biochemical data, and treatment timing.
Main Results:
- Gastroenteritis, fever, hyporexia, and neurological signs were common admission reasons.
- Dehydration at admission and inadequate home steroid management were linked to AC.
- Endocrinologist consultation was more frequent in AC patients.
Conclusions:
- Children with AI presenting to the ED may have acute, life-threatening conditions.
- Education for AI patients and families is vital for home management.
- Collaboration between pediatric endocrinologists and ED staff is essential for early AC recognition and treatment.
Background:
In patients with adrenal insufficiency (AI), adrenal crisis (AC) represents a clinical emergency. Early recognition and prompt management of AC or AC-risk conditions in the Emergency Department (ED) can reduce critical episodes and AC-related outcomes. The aim of the study is to report the clinical and biochemical characteristics of AC presentation to improve their timely recognition and proper management in a ED setting.
Methods:
Single-centre, retrospective, observational study on pediatric patients followed at the Department of Pediatric Endocrinology of Regina Margherita Children's Hospital of Turin for primary AI (PAI) and central AI (CAI).
Results:
Among the 89 children followed for AI (44 PAI, 45 CAI), 35 patients (21 PAI, 14 CAI) referred to the PED, for a total of 77 accesses (44 in patients with PAI and 33 with CAI). The main causes of admission to the PED were gastroenteritis (59.7%), fever, hyporexia or asthenia (45.5%), neurological signs and respiratory disorders (33.8%). The mean sodium value at PED admission was 137.2 ± 1.23 mmol/l and 133.3 ± 1.46 mmol/l in PAI and CAI, respectively (p = 0.05). Steroids administration in PED was faster in patients with CAI than in those with PAI (2.75 ± 0.61 and 3.09 ± 1.47 h from PED access, p = 0.83). Significant factors related to the development of AC were signs of dehydration at admission (p = 0.027) and lack of intake or increase of usual steroid therapy at home (p = 0.059). Endocrinological consulting was requested in 69.2% of patients with AC and 48.4% of subjects without AC (p = 0.032).
Conclusion:
children with AI may refer to the PED with an acute life-threatening condition that needs prompt recognition and management. These preliminary data indicate how critical the education of children and families with AI is to improve the management at home, and how fundamental the collaboration of the pediatric endocrinologist with all PED personnel is in raising awareness of early symptoms and signs of AC to anticipate the proper treatment and prevent or reduce the correlated serious events.
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