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Adrenal function in pediatric critical illness.

Kusum Menon1, Cheril Clarson

  • 1Children's Hospital of Eastern Ontario and the University of Ottawa; and the Department of Pediatrics, the University of Western Ontario, Children's Hospital of Western Ontario, London, ON, Canada.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 5, 2003
PubMed
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Adrenal dysfunction occurs in 31% of critically ill children. This study investigated adrenal function in pediatric critical illness, finding inadequate basal cortisol levels in some patients facing severe stress.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Pediatric Critical Illness

Background:

  • Adrenal dysfunction is known in adult critical illness and pediatric septic shock.
  • Limited data exists on adrenal function in diverse pediatric critical illness populations.
  • This study addresses the knowledge gap regarding adrenal function in critically ill children.

Purpose of the Study:

  • To investigate the occurrence and characteristics of adrenal dysfunction in critically ill children.
  • To assess adrenal reserve using adrenocorticotropic hormone (ACTH) stimulation tests.
  • To explore potential correlations with illness severity and diagnoses.

Main Methods:

  • Prospective, descriptive study of 13 critically ill children with high Pediatric Risk of Mortality (PRISM) scores and hemodynamic instability.

Related Experiment Videos

  • Measured baseline cortisol and ACTH levels.
  • Administered ACTH stimulation tests to evaluate adrenal reserve.

    • Main Results:

    • Adrenal dysfunction was observed in 31% of patients (4/13).
    • Defined as baseline cortisol <7 &mgr;g/dL or post-ACTH <18 &mgr;g/dL.
    • No significant difference in PRISM scores or diagnoses between those with and without adrenal dysfunction.

    Conclusions:

    • Critically ill children may exhibit inadequate basal cortisol levels during severe physiologic stress.
    • ACTH stimulation tests are valuable for delineating hypothalamic-pituitary-adrenal axis function in this population.
    • Further research is needed to determine the clinical consequences of these biochemical abnormalities.