Introduction
AC incidence, morbidity, and mortality
Study type and author (reference) | Year | Country | Age (yrs) | Design/sample | AC incidence (by age group) | |
---|---|---|---|---|---|---|
Adolescent | Early Adult | |||||
Retrospective study of AC in childhood | ||||||
Chrisp et al. [24] | 2018 | Australia | 0–18 | Audit/CAH | 4 ACs (6.9% admissions)b | – |
Rushworth et al. [27] | 2021 | Australia | 0–18 | Audit/SAI | – | – |
Eyal et al. [30] | 2019 | Israel | 0–18 | Audit/All AI | – | – |
Population-based (children) | ||||||
Rushworth et al. [22] | 2017 | Australia | 0–18 | National data/All AI | 7.2/million/yr (15–19 yrs)a | – |
Rushworth et al. [25] | 2016 | Australia | 0–18 | Hospital data/CAH | 5 ACs (5.7% admissions) | – |
Population-based (adults) | ||||||
Rushworth et al. [23] | 2014 | Australia | 18+ | Admission data/all AI | – | 8.3/million/yr (20–29 yrs) |
Retrospective study of AC/AI in adulthood | ||||||
Reisch et al.a [27] | 2012 | Germany | 18+ | Mixed/incl record review/CAH | – | |
Goubar et al. [28] | 2019 | Australia | 18+ | Audit/hospital records/PAI | – | 40% of 41 admissionsc |
Omori et al. [26] | 2003 | Japan | All AI (majority SAI) | – | 4 ACs in SAI patients only |
Epidemiological considerations
Definitional issues, clinical factors, and treatment
Definition
Clinical factors
Recommendations for treatment of AI/AC
Age group | Hydrocortisone | Fluids | Additional measures (if relevant) |
---|---|---|---|
Adults | Prompt administration of 100 mg IV (or IM) | IV 1000 ml of normal saline (0.9% isotonic sodium chloride) in the first hour | Antibiotic therapy, admission to intensive care or high-dependency unit, administration of low dose heparin |
Follow with 200 mg every 24 h (continuous infusion or IV/IM boluses (50 mg) every 6 h | Add IV dextrose to 5% concentration in normal saline, if hypoglycaemic | ||
If initial treatment is successful (usually after 24 h), oral hydrocortisone at 2 to 3 times the usual dose, tapering to the usual dose over the next 2 to 3 daysa | Then administer crystalloid fluids according to standard resuscitation guidelinesb | ||
Adolescents and young adults | Please use the recommendations for adults or children depending on age and development stage | ||
Children | Prompt administration hydrocortisone at 50 mg per square metre of body-surface area IV (or IM), followed by 50–100 mg per square metre every 24 h, given as a continuous infusion or IV (or IM) boluses (12.5–25 mg per square metre) every 6 h | Bolus of normal saline at a dose of 20 ml per kilogram of body weight, with repeated doses up to a maximum of 60 ml per kilogram in the first hour, along with intravenous dextrose, 0.5–1 g per kilogram, if hypoglycaemic | |
If initial treatment is successful (usually after 24 h), oral hydrocortisone at 2 to 3 times the usual dose, tapering down to the usual dose over the next 2 to 3 daysa | Then administer crystalloid fluids according to standard resuscitation guidelinesb |