Adrenal Insufficiency: Pediatric Fellow of Endocrine, Diabetes, How - - PowerPoint PPT Presentation

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Adrenal Insufficiency: Pediatric Fellow of Endocrine, Diabetes, How - - PowerPoint PPT Presentation

Aug 23, 2022 309 likes •529 views

Patrick Rizzuto, MD Adrenal Insufficiency: Pediatric Fellow of Endocrine, Diabetes, How to deal with urgencies/ and Metabolism emergencies at school PGY4 Adapted from previous presentation given by Emily R. Miller, DO Objectives By the end of

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Adrenal Insufficiency:

How to deal with urgencies/ emergencies at school

Patrick Rizzuto, MD Pediatric Fellow of Endocrine, Diabetes, and Metabolism PGY4

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Adapted from previous presentation given by Emily R. Miller, DO

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Objectives

By the end of this lecture, attendees should be able to….

  • 1. Recognize the role of adrenal glands

in maintaining health

  • 2. Identify causes of adrenal

insufficiency

  • 3. Recognize and manage an acute

crisis in adrenal insufficiency

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Adrenal Glands

  • Sit on kidneys (“ad”‐”renal”)
  • Two major zones
  • Responsible for production of many

hormones, including cortisol and aldosterone

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Cortisol

  • Various roles in body

Blood sugar Blood pressure Increase energy Promote appetite Control inflammation

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Pituitary Gland Adrenal Glands ACTH Cortisol

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Pituitary Gland Adrenal Glands ACTH Cortisol

“Central” Adrenal Insufficiency

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Pituitary Gland Adrenal Glands Cortisol

“Primary” Adrenal Insufficiency

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Causes of Adrenal Insufficiency

Primary Causes:

  • Congenital Adrenal

Hyperplasia

  • Addison’s Disease
  • Medications
  • Hemorrhage
  • Surgical Removal

Central Causes:

  • Hypopituitarism
  • Autoimmune

inflammation

  • Medications
  • Post‐radiation

therapy

  • Surgery
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Basic Management

  • Replace the steroids!
  • Physiologic replacement
  • “Stress doses”
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What is an “Adrenal Crisis”?

  • “Stress hormone”
  • Body needs different amount of

cortisol at different times

  • You’re stressed? Need stress

hormone!

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Possible Causes

  • Withdrawal
  • Illness
  • Injury
  • Other significant stress (can be mental)
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What symptoms indicate there is a problem?

  • Vomiting
  • Lethargy
  • Fever
  • Weakness
  • Fainting
  • Dehydration
  • Confusion, LoC
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What should I do if my student is ill?

Ask: “Is the student awake and able to swallow?”

  • 1. Contact parent
  • 2. Give oral stress dosing

as outlined by family/physician

  • 1. Give IM hydrocortisone

(Solu‐cortefR)

  • 2. Call 911
  • 3. Contact family

Yes No

*EMS often cannot give Solu‐Cortef!

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How do I inject hydrocortisone if needed?

  • 1. Wash hands and remove plastic cap
  • 2. Push down on plastic top to mix the liquid

and powder in the lower part of the vial

  • 3. Gently shake the solution until it is clear
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How do I inject hydrocortisone if needed?

  • 4. Clean rubber stopper with alcohol
  • 5. Place needle through center plunger until

tip is visible in bottle

  • 6. Hold vial upside‐down and draw

hydrocortisone into the syringe

  • 7. Inject into the thigh muscle
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What if I still don’t know if I should escalate care?

  • When in doubt, treat

– Unnecessary hydrocortisone won’t hurt – Not giving stress dose when needed could result in shock – can be fatal

  • Talk with parents/guardians
  • Talk with on‐call endocrinologist:

(804)828‐0951

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Questions?

Picture from:www.iheartguts.com