[Adrenal function in children with sepsis and septic shock]

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Infectious Diseases

Background:

• Sepsis and septic shock in children can lead to complex endocrine dysfunctions.
• Adrenal insufficiency is a potential complication, impacting hemodynamic stability and outcomes.
• Petechiae in pediatric sepsis may indicate underlying adrenal compromise.

Purpose of the Study:

• To evaluate adrenal function in pediatric patients with sepsis and septic shock presenting with petechiae.
• To explore the relationship between adrenal hypofunction, adrenal hemorrhage, and clinical factors.
• To identify early indicators of adrenal dysfunction in critically ill children.

Main Methods:

• Prospective observational study involving 24 pediatric patients with sepsis/septic shock and petechiae.
• Comparison with 26 healthy children as controls.
• Measurement of plasma cortisol and adrenocorticotropic hormone (ACTH) via radioimmunoassay; adrenal ultrasonography performed.

Main Results:

• Elevated plasma cortisol and ACTH levels observed in the patient group compared to controls.
• Adrenal insufficiency identified in 4 out of 24 patients.
• Patients with adrenal insufficiency showed increased need for noradrenaline, higher incidence of necrotic purpura, massive adrenal hemorrhage, lower platelet counts, reduced prothrombin activity, lower fibrinogen, higher PRISM III scores, and increased mortality.

Conclusions:

• Children with sepsis and septic shock exhibit increased plasma cortisol and ACTH levels.
• Adrenal insufficiency is infrequent but significantly associated with severe outcomes.
• Associations found between adrenal insufficiency, hemodynamic failure, purpura, coagulopathy, adrenal hemorrhage, and mortality.