Read about the potential impact of a brain tumour diagnosis or its treatment on the function of the adrenal glands and how this can affect your child.
Key points
The adrenal glands produce hormones that help the body respond to stress and illness. They are controlled, in part, by hormones from the pituitary gland, which is in the brain.
Some types of tumours may damage the pituitary gland, which can affect the ability to activate the adrenal glands, and thus reduce their ability to make stress hormones. Radiation therapy can also affect the pituitary gland.
If the adrenal glands are not working properly it is referred to as "adrenal insufficiency".
Adrenal insufficiency can be treated with daily doses of hydrocortisone.
For children with a diagnosis of adrenal insufficiency, it is important to give higher doses of medication during periods of physical stress, such as illness or surgery.
Introduction
Adrenal gland functionThe pituitary gland triggers the adrenal glands to produce hormones that help our bodies cope with stress or illness.
The adrenal glands are triangle-shaped glands located above the kidneys. They produce several different hormones. One important hormone they release is a steroid hormone called cortisol. The adrenal glands release cortisol to help our bodies respond to stress or illness.
The adrenal gland is activated by the
pituitary gland. The pituitary gland produces a hormone called adrenocorticotrophin (ACTH), which travels to the adrenal gland and triggers it to make cortisol.
Certain
tumours, or their treatment, can affect the ability of the pituitary gland to activate the adrenal glands.
If the adrenal gland is not working properly or if it is not activated, then it may not be able to produce enough cortisol. This is called adrenal insufficiency.
Signs and symptoms
What are the symptoms of adrenal insufficiency?
Some of the symptoms associated with adrenal insufficiency are:
fatigue and/or weakness
weight loss or loss of appetite
light-headedness
low blood pressure
nausea and vomiting
low blood sugar
These symptoms can develop quickly, or progress slowly over 20 years or more.
Causes, risk factors and prevalence
What causes adrenal insufficiency?
Although rare, the pituitary gland may be damaged by certain tumours, by surgery to remove these tumours or by radiation therapy. This can affect the pituitary gland's ability to produce ACTH. If there is no ACTH, not enough cortisol will be produced day-to-day and when the body is under physical stress.
Diagnosis
How do we screen for adrenal insufficiency?
During follow-up clinic visits, symptoms will be monitored. Blood levels of cortisol may be measured. This is typically done first thing in the morning, when cortisol levels are highest. Sometimes a special test is done in the hospital by administering a medication to stimulate cortisol release.
Treatment
What can be done to treat adrenal insufficiency?
If there is concern that the adrenal glands are not functioning adequately, a referral will be made to an endocrinologist, a doctor who specializes in diagnosing and treating hormone problems.
Adrenal insufficiency can be treated with daily doses of hydrocortisone (cortisol). It is taken by mouth in a pill or liquid form.
During times of physical stress, illness or surgery, the dose of hydrocortisone needs to be increased.
Follow-up care
How will this affect your child’s future?
Children who are affected by adrenal insufficiency need to take hydrocortisone throughout their lives and will need to take higher doses during periods of physical stress.
When adequate doses are taken routinely, the symptoms associated with adrenal insufficiency can be avoided.
If adrenal insufficiency is not treated it can lead to the symptoms described above. During times of physical stress or when undergoing anesthesia, if adequate doses are not given, life-threatening shock may occur. In such cases an injection of hydrocortisone must be given immediately to prevent severe illness.
