Q: We’ve noticed in past few years that there seems to be a “seasonal” change in our 5-year-old son with SWCAH as the hotter weather arrives. He seems to go thru fits of rage/anger and extreme emotional volatility. We then have blood tests done to determine levels, and he doesn’t get too far out of range. We have him drinking and staying hydrated all day but can’t figure out if he’s getting oversuppressed/undersuppressed within a given day but “ok” overall over a longer time period (so it doesn’t manifest itself during blood tests). Just wondering what we should be thinking/doing differently given it seems to be a pattern with hot weather coming into play? Thanks so much in advance for your guidance.
A: I have a few thoughts given the observation that it seems to be seasonal, and it doesn’t seem to show up in blood tests. It is certainly possible that the blood tests, which are after all just a snapshot in time, simply aren’t catching the fluctuations, as you mentioned.
The manifestation of emotional volatility could be related to higher androgen levels, or it could also be due to low sodium levels, which may be making him irritable. In extremely hot weather, salt-wasters are certainly at higher risk for dehydration, but they also at risk for low sodium. It is important to keep him well-hydrated, as you mentioned, but he also probably has increased sodium requirements (FYI, Gatorade has plenty of glucose, but very little sodium). Some salt-wasters find that they do better with extra Florinef on particularly hot days when they are going to be outside for extended periods of time (and/or doing strenuous activity).
You could ask your endocrinologist if a little extra Florinef on those occasions might benefit your son as well. The hot weather itself can raise the body’s core temperature slightly, which in turn can speed up the body’s metabolism, so his requirements for Cortef may also be slightly increased. If you do end up giving him little more Florinef, Florinef actually has some glucocorticoid (Cortef) activity as well, and that could be enough to suppress any extra androgens that may be occurring during the hot weather.
I would certainly talk with your endocrinologist before doing anything, but hopefully we can find a way to help your son during the hot weather.