title: The etiologies of adrenal insufficiency in 73 Thai children: 20 years experience.
abstract: BACKGROUND
  Adrenal insufficiency (AI) is an event caused by an inadequate secretion or action of adrenal hormones. It can be classified as primary (1 degree) and secondary (2 degree). AI may result in severe morbidity and mortality when undiagnosed or ineffectively treated.
  
  
  OBJECTIVE
  To determine the etiologies of AI in Thai children.
  
  
  METHODS
  Data of children with AI presented to the authors' pediatric endocrine service between 1982 and 2002 (20 years) were retrospectively collected and analyzed.
  
  
  RESULTS
  AI was diagnosed by clinical and laboratory data in 73 children (31 boys and 42 girls). Sixty-two (84.9%) patients had 1degree AI while 11 (15.1%) had 2 degree AI. The majority of patients with 1 degree AI (87.1%) were diagnosed with congenital adrenal hyperplasia (CAH). Other causes of 1 degree AI were uncommon such as ACTH unresponsiveness (4.8%) and no definite diagnosis (8.1%). Most children with 1 degree AI presented with hyperpigmentation. Causes of 2 degree AI were as follows: panhypopituitarism (63.6%), isolated ACTH deficiency (9.1%), and low birth weight (27.3%).
  
  
  CONCLUSIONS
  In the present study, CAH was the most common cause of 1 degree AI while panhypopituitarism was the most common cause of 2 degree AI. Other causes of AI were quite uncommon. Definite causes of AI have not yet been identified in some children. Further clinical observation and special tests including molecular studies in these children are warranted for diagnostic and prognostic importance.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Prapanrat
authors.initials: P
authors.lastname: Osuwannaratana
authors.forename: Saroj
authors.initials: S
authors.lastname: Nimkarn
authors.forename: Jeerunda
authors.initials: J
authors.lastname: Santiprabhob
authors.forename: Supawadee
authors.initials: S
authors.lastname: Likitmaskul
authors.forename: Pairunyar
authors.initials: P
authors.lastname: Sawathiparnich
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications; D000309:Adrenal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017495:Hyperpigmentation; D007018:Hypopituitarism; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors