Addison's Disease in Children
Addison's is rare in kids, but when it does appear, parents often feel overwhelmed. Here's what you need to know: the basics, what to look for, and how families can manage it together.
What is Addison's in a child?
Addison's disease (primary adrenal insufficiency) means the adrenal glands—small glands that sit on top of each kidney—aren't producing enough hormones. The main one is cortisol, which helps the body handle stress, blood sugar, and inflammation. Kids with Addison's often have low aldosterone too, which affects salt and water balance and blood pressure. The condition is uncommon and tends to affect girls slightly more often than boys. It can show up at any age, including early childhood.
What causes it?
In most children, the immune system mistakenly attacks the adrenal glands. Other causes include infection, cancer, surgery that removes the glands, or a rare inherited condition. A family history of Addison's or other autoimmune disorders can increase the risk.
Who might be at higher risk?
Families should be aware if a child already has another autoimmune condition, such as type 1 diabetes or thyroid disease. Vitiligo, tuberculosis, or certain cancers can also be associated. A family history of Addison's or autoimmune diseases may warrant closer monitoring.
Signs and symptoms to watch for
Early on, symptoms can be subtle and may only show up during illness or stress. Parents might notice:
- Tiredness, muscle weakness, or feeling dizzy
- A fast or fluttery pulse
- Darkening of the skin, especially on hands, face, or in skin folds
- Patches of dark freckles or bluish-black areas around nipples, mouth, or groin
- Weight loss, poor appetite, or craving salty foods
- Nausea, vomiting, or diarrhea
- Muscle aches or feeling cold when others are comfortable
- Dehydration even when drinking fluids
Many of these can point to other conditions too. If you notice a combination of these, especially with skin darkening or salt craving, a doctor visit is important.
How is it diagnosed?
The doctor will review your child's symptoms and family history, then order blood tests to check cortisol and related hormone levels. The ACTH stimulation test is often used: your child gets a small dose of synthetic ACTH, and the response is measured. In Addison's, the adrenal glands don't respond as they should. Sometimes a CT scan of the adrenal area is done to look for structural changes.
How is it treated?
Treatment aims to replace the missing hormones so your child can lead a normal, active life. Because untreated Addison's can be serious, doctors usually start therapy quickly. Corticosteroids (such as hydrocortisone) are given by mouth daily, or by injection if your child is too unwell to take pills. Most children will need this for life. Some also need fludrocortisone to maintain salt and potassium balance. Your endocrinologist will tailor the doses to your child.
Possible complications if left untreated
Without treatment, children can develop severe weakness, very low blood pressure, kidney problems, shock from dehydration, or dangerous drops in blood sugar. These are most likely during illness, injury, or surgery. With proper care and stress dosing when needed, these risks are greatly reduced.
Daily life and staying safe
Addison's is lifelong, but kids can go to school, play sports, and grow up normally. The key is never missing medication and knowing when to increase doses—for example, during fever, stomach bugs, surgery, or major stress. Always discuss any planned surgery with your doctor beforehand. A medical alert bracelet or necklace helps caregivers and emergency responders act quickly if needed.
Caring for a child with a chronic condition can be hard on the whole family. It's okay to ask for support—emotional, practical, or financial—from your care team or local support groups.
When to call the doctor or seek care
Call your child's doctor if you see possible symptoms of Addison's. If your child already has Addison's, seek care right away—and consider stress dosing—when they have vomiting, diarrhea, fever, or any infection. Before any surgery or procedure, check in with your endocrinologist about dose adjustments.
Quick takeaways
- Addison's means the adrenal glands don't make enough cortisol and often aldosterone.
- With daily medication and stress dosing when needed, children can live full lives.
- The most common cause in kids is autoimmune damage to the adrenal glands.
- Skin darkening and salt craving are important clues to watch for.
- Never hesitate to seek care during illness—vomiting and diarrhea need prompt attention.
Getting the most from doctor visits
- Write down your questions before the visit so you don't forget anything.
- Note any new medicines, doses, or instructions the doctor gives.
- Ask about stress dosing—when and how much to increase during illness.
- Save your doctor's after-hours contact info somewhere easy to find.
- Create a free emergency card so schools and caregivers know what to do in a crisis.