Question Title: secondary addisons

My son age 61/2 has secondary addisons due to steriod use for chronic respitory infection (immune deffenciency) and severe asthma. He also has poly arthritis and epilepsy. It has taken about 10 months but we finally have him mostly at maintenance dose of 10mg a day given in 3 divided doses. My question is if we continue to decrease the dose extremely slow as our endocrinologist wants to, what are the chances that his acth and cortisol production will resume normally? What will keep him from having symptoms and/or going into a crisis during the reduction period and his own body producing cortisol? He also has growth failure (bone age 31/2) what is your opinion that this will also resume without growth hormone?

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Dear Lora,
Your son has adrenal insufficiency (Addison’s) because of the steroids he is on. Steroids given by mouth suppress the adrenal gland because they inhibit the production of ACTH by the pituitary. ACTH is the hormone made in the pituitary gland that controls the secretion of cortisol by the adrenal. The doctors are trying to reduce the dose of steroids your son is on so that the pituitary will start making ACTH again and so that this ACTH will cause the adrenal gland to begin making the normal amount of cortisol your son needs. Any decrease in the dose of steroids needs to be done very slowly so that the pituitary and adrenal glands have time to recover (this doesn’t happen overnight). There is a very good chance that your son’s pituitary and adrenal glands will begin working normally once his steroid use is reduced to sufficiently low levels. While his steroid use is being reduced, adrenal crisis can be prevented by giving higher doses of cortisol if he should have any significant medical problem such as fever, broken bone, or surgery, or if he should have any sign of adrenal insufficiency such as vomiting, lethargy or shock.. Once his steroids are stopped, his chances of “catching up” on his growth are excellent. You should see a pediatric endocrinologist at regular intervals so that your son’s growth and development can be appropriately monitored after he stops his steroid treatment.
HFHS.RN-AM
*KEYWORD: Addison's disease, steroids, Adrenal Insufficiency

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