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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.

The Endocrine System

The body’s endocrine system produces hormones. They control most of the body’s functions such as growth, puberty, energy level, urine production, and stress response.

The endocrine system is a group of glands located through the body. The pituitary gland, located in the brain, is sometimes called “the master gland” because it controls other glands such as the thyroid, adrenals, ovaries (in females), and testes (in males.)  

A graphic showing the pituitary gland's location in the brain. Labeled parts of the pituitary gland are the optic chasm, pars tuberalis, anterior lobe, posterior lobe, stalk, median eminence, and hypothalamus.

The pituitary gland is sometimes called “the master gland” because it controls other glands such as the thyroid, adrenals, ovaries, and testes.

What Problems Can Occur

One hormone problem is central adrenal insufficiency.

The pituitary gland produces a hormone called adrenocorticotropic hormone (ACTH). It 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.

What Treatments/ Conditions Can Cause Central Adrenal Insufficiency

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

Signs and Symptoms

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

  • Fatigue
  • Weakness
  • Poor appetite
  • Dizziness

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

  • Vomiting
  • Diarrhea
  • Low blood sugar
  • Dehydration

What Survivors Can Do

Screening

Survivors who had radiation to the central area of the brain should have a yearly measurement of a morning cortisol blood level to screen for central adrenal insufficiency. Survivors experiencing symptoms of central adrenal insufficiency such as worsening and persistent fatigue and unexplained and frequent illnesses should discuss these symptoms with their medical providers. They may then consider a laboratory evaluation or a referral to see an endocrinologist.

Treatment for Central Adrenal Insufficiency

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

In certain situations such as illness or surgery, patients may get an increased dose by injection.

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


Reviewed: June 2018

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