Central Adrenal Insufficiency

Some childhood cancer treatments can cause problems with the body’s hormones.

Hormones take chemical messages from the brain to internal organs.

Learn More About the Endocrine System

What is central adrenal insufficiency?

One hormone problem is central adrenal insufficiency. It affects the adrenal glands. They are located on top of the kidneys.

A deficiency in a pituitary hormone called adrenocorticotropic hormone (ACTH) causes central adrenal insufficiency. ACTH tells the adrenal gland to make a hormone called cortisol.

If the pituitary gland doesn’t make ACTH, the body doesn’t make cortisol. Cortisol keeps blood sugar at a normal level and helps the body deal with physical stress such as fever, illness, and severe injuries.

Causes of central adrenal insufficiency

• Radiation to the brain
• Surgical removal of the pituitary gland
• Tumors near the pituitary gland, even without surgery

Signs and symptoms of central adrenal insufficiency

Under normal circumstances, symptoms may not occur. If they do, they are usually mild. They may include:

• Fatigue
• Weakness
• Poor appetite
• Dizziness

Stress such as fever, infection, surgery, or injury can cause more severe symptoms:

• Vomiting
• Diarrhea
• Low blood sugar
• Dehydration

What survivors can do

Know your risks and monitor your health

Ask your oncologist about your risks of developing late effects.

Inform your primary health care provider about your risks. Share a copy of your Survivorship Care Plan, which includes a treatment summary. The summary includes details about your cancer treatment and information about health problems that may occur because of treatment.

Screening

Survivors who had radiation (30 Gy or higher) to the central area of the brain (hypothalamic-pituitary axis) should have a yearly measurement of a morning cortisol blood level or a yearly evaluation by an endocrinologist.

Treatment for central adrenal insufficiency

Treatment is hydrocortisone. It is a daily medication given by mouth.

In time of extreme stress such as illness or surgery, patients may get an increased dose, sometimes by injection.

Patients with central adrenal insufficiency should wear a medical alert bracelet. During an emergency, it will alert medical workers to the condition.