Protocolo de avaliação e conduta na insuficiência adrenal em pediatria

Abstract

Adrenal insufficiency is a potentially life-threatening endocrine disorder characterized by inadequate production of glucocorticoids and, in primary forms, mineralocorticoids. In children and newborns, its clinical presentation is often nonspecific, which contributes to delayed diagnosis and an increased risk of adrenal crises. Given the etiological diversity, age-related clinical variability and the specific challenges of pediatric management, the standardization of evidence-based clinical approaches is essential. This study aimed to develop a clinical protocol based on current scientific evidence, through a systematic literature review, to guide the diagnosis, management and follow-up of adrenal insufficiency in different clinical contexts, with emphasis on early identification, appropriate therapeutic strategies and prevention of adrenal crises. The literature search was conducted in the PubMed database using descriptors related to adrenal insufficiency, diagnosis and treatment, including studies published within the last five years, as well as official guidelines from the Brazilian Society of Endocrinology and Metabolism, the Endocrine Society and the Brazilian Ministry of Health. After screening and application of eligibility criteria, 18 studies were included in the review. The results revealed a wide range of clinical contexts, including neonatal adrenal insufficiency, genetic, autoimmune, infectious and iatrogenic causes, as well as physiological stress-related situations associated with adrenal crises. Based on these findings, a structured clinical protocol was proposed, comprising a diagnostic flowchart, etiology-specific management, body surface area-adjusted therapeutic guidelines, care in high-risk situations and health education strategies. It is concluded that the systematization of a clinical care protocol may contribute to early recognition of adrenal insufficiency, reduction of complications and improvement in the safety and quality of pediatric care.