title: Diagnosis and management of pediatric adrenal insufficiency.
abstract: BACKGROUND
  Adrenal insufficiency (AI) is a wellknown cause of potentially life-threatening disorders. Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function, leading to varying degrees of glucocorticoid (GC) deficiency. Iatrogenic AI induced by exogenous GCs is the most common cause of AI. The criteria for the diagnosis and management of iatrogenic AI, neonatal AI, and critical illness-related corticosteroid insufficiency (CIRCI) are not clear.
  
  
  METHODS
  We reviewed the recent original publications and classical data from the literature, as well as the clinical, diagnostic and management strategies of pediatric AI.
  
  
  RESULTS
  Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI, neonatal AI, and CIRCI are provided. Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI, GC treatment has to be tailored to highly suggestive clinical symptoms and signs. Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy. It is mainly the delay in treatment that is responsible for mortality in adrenal crisis.
  
  
  CONCLUSIONS
  Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.
authors.affiliation: Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey. aucar76@yahoo.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uçar
authors.affiliation: Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Firdevs
authors.initials: F
authors.lastname: Baş
authors.affiliation: Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Nurçin
authors.initials: N
authors.lastname: Saka
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D005938:Glucocorticoids
keywords: adrenal insufficiency; critical illness; hypothalamo-pituitary-adrenal axis; iatrogenic; steroids