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Absolute and relative adrenal insufficiency in children with septic shock

Cristiane F Pizarro1, Eduardo J Troster, Durval Damiani

  • 1Pediatric Intensive Care Unit, Department of Pediatrics, Instituto da Criança Pedro de Alcântra, Faculdade de Medicina. Universidade de São Paulo, São Paulo-SP 01238-000, Brazil. troster@einstein.br

Critical Care Medicine
|April 9, 2005
PubMed

Insights

Adrenal insufficiency is common in pediatric septic shock, particularly in cases resistant to catecholamines. Further research is needed to determine if corticosteroid therapy improves survival in these critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pediatric Endocrinology
  • Pediatric Infectious Diseases

Background:

  • Corticosteroid replacement is known to improve outcomes in adults with relative adrenal insufficiency and catecholamine-resistant septic shock.
  • The role of adrenal insufficiency in pediatric septic shock, especially catecholamine-resistant cases, requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between absolute and relative adrenal insufficiency and catecholamine-resistant septic shock in children.
  • To determine the prevalence of adrenal insufficiency in pediatric septic shock.

Main Methods:

  • A prospective cohort study was conducted in a university hospital's pediatric intensive care unit in Brazil.
  • Fifty-seven children diagnosed with septic shock were included, excluding those with HIV, prior adrenal insufficiency, or recent steroid/etomidate use.
  • A short corticotropin test was performed, measuring cortisol levels at baseline, 30, and 60 minutes to define absolute and relative adrenal insufficiency.

Main Results:

  • Absolute adrenal insufficiency was found in 18% of children, all with catecholamine-resistant shock.
  • Relative adrenal insufficiency was observed in 26% of children, with 80% experiencing catecholamine-resistant shock.
  • Children with any form of adrenal insufficiency had a significantly increased risk of catecholamine-resistant shock (RR 1.88).

Conclusions:

  • Absolute and relative adrenal insufficiency are prevalent in children with catecholamine-resistant septic shock.
  • Adrenal insufficiency was absent in children with fluid-responsive shock.
  • Further studies are necessary to ascertain the survival benefits of corticosteroid therapy in pediatric patients with relative adrenal insufficiency and catecholamine-resistant septic shock.
Abstract

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