Endocrine Abstracts

Adrenal insufficiency (AI) is characterised by a lack of cortisol production from the adrenal glands. This can be a primary adrenal disorder or secondary to adrenocorticotropic hormone (ACTH) deficiency or suppression from exogenous glucocorticoids. Symptoms of AI in children may initially be non-specific and include growth faltering, lethargy, poor feeding, abdominal pain, vomiting and prolonged recovery from infections. AI is treated with replacement doses of hydrocortisone, which, at times of physiological stress such as illness, trauma or surgery needs to be increased to avoid adrenal crises and death. Currently there are no unified guidelines for AI in those <18 years old in the UK; this can lead to a substantial variation in the management of AI in both emergency and peri-operative situations. In 2021 the Paediatric AI Group was set up under the auspices of the British Society of Paediatric Endocrinology & Diabetes (BSPED) in an effort to standardise the management of paediatric AI across the UK and NI. The group consisted of 16 individuals from 10 UK tertiary endocrine units with further input from the BSPED clinical and executive committees as well as stakeholder engagement. The management principles were used to create documents on sick day glucocorticoid recommendations, peri-operative advice, and a new BSPED emergency card; all linked and accessible from a dedicated page on the BSPED website. This standardisation of management and ready access to information should allow prevention as well as timely recognition and treatment of AI and adrenal crises in children.