Bilateral congenital adrenal agenesis: a rare disease entity and not a result of poor autopsy technique

Adrenal Insufficiency with Hypoglycemia in a Medically Complex Pediatric Patient

Medically complex children present a low frequency but often high acuity patient population for Emergency Medical Services (EMS) personnel. We present a case of a 12-year-old male with Duchenne muscular dystrophy and adrenal agenesis found unresponsive. Detailed history-taking was crucial for diagnostic accuracy and this patient's favorable outcome. This case highlights the importance of recognizing adrenal insufficiency-induced hypoglycemia in patients presenting with altered mental status. Emergency Medical Services personnel should be trained to identify and manage adrenal insufficiency, using detailed histories and on-scene medical oversight to improve outcomes.

Development and function of the fetal adrenal

The adrenal cortex undergoes multiple structural and functional rearrangements to satisfy the systemic needs for steroids during fetal life, postnatal development, and adulthood. A fully functional adrenal cortex relies on the proper subdivision in regions or 'zones' with distinct but interconnected functions, which evolve from the early embryonic stages to adulthood, and rely on a fine-tuned gene network. In particular, the steroidogenic activity of the fetal adrenal is instrumental in maintaining normal fetal development and growth. Here, we review and discuss the most recent advances in our understanding of embryonic and fetal adrenal development, including the known causes for adrenal dys-/agenesis, and the steroidogenic pathways that link the fetal adrenal with the hormone system of the mother through the fetal-placental unit. Finally, we discuss what we think are the major open questions in the field, including, among others, the impact of osteocalcin, thyroid hormone, and other hormone systems on adrenal development and function, and the reliability of rodents as models of adrenal pathophysiology.