The Etiologies of Adrenal Insufficiency in 73 Thai Children: 20 Years Experience
Prapanrat Osuwannaratana MD*, Saroj Nimkarn MD*, Jeerunda Santiprabhob MD*, Supawadee Likitmaskul MD*, Pairunyar Sawathiparnich MD*
Affiliation : * Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Background : Adrenal insufficiency (AI) is an event caused by an inadequate secretion or action of adrenal
hormones. It can be classified as primary (1°) and secondary (2°). AI may result in severe morbidity and
mortality when undiagnosed or ineffectively treated.
Objective : To determine the etiologies of AI in Thai children
Material and Method: 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 1° AI while 11 (15.1%) had 2° AI. The majority of patients with 1° AI (87.1%) were
diagnosed with congenital adrenal hyperplasia (CAH). Other causes of 1° AI were uncommon such as ACTH
unresponsiveness (4.8%) and no definite diagnosis (8.1%). Most children with 1° AI presented with hyperpig-
mentation. Causes of 2° AI were as follows: panhypopituitarism (63.6%), isolated ACTH deficiency (9.1%),
and low birth weight (27.3%).
Conclusion : In the present study, CAH was the most common cause of 1° AI while panhypopituitarism was the
most common cause of 2° 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.
Keywords : Adrenal insufficiency, Children, Etiologies, Congenital adrenal hyperplasia
