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Published on: August 19, 2020
Adrenal insufficiency in the critically ill neonate and child
Monica Langer1, Biren P Modi, Michael Agus
1Children's Hospital Boston, Harvard Medical School, USA.
Insights
Adrenal insufficiency is a key concern in critically ill children, impacting morbidity. Diagnostic testing via adrenocorticotropin stimulation tests is recommended for shock patients unresponsive to standard treatment.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Neonatology
Background:
- Adrenal insufficiency is increasingly recognized in critically ill pediatric patients.
- Recent studies highlight its high prevalence and morbidity in pediatric septic shock.
- Neonatal research has improved understanding of diagnostic testing and outcomes.
Purpose of the Study:
- To review the diagnostic approach for adrenal insufficiency in critically ill children and infants.
- To outline the clinical consequences of adrenal insufficiency in this population.
- To discuss current therapeutic strategies for adrenal insufficiency in critically ill patients.
Main Methods:
- Review of current literature on adrenal insufficiency in pediatric critical care.
- Analysis of diagnostic testing methodologies, including cortisol level comparisons.
- Evaluation of clinical outcomes and therapeutic interventions.
Main Results:
- Adrenal insufficiency is prevalent in pediatric septic shock, associated with significant morbidity.
- Total cortisol testing is useful in pediatric septic shock patients.
- Diagnostic testing and clinical outcomes in preterm infants have been clarified.
Conclusions:
- Adrenal insufficiency contributes to morbidity in critically ill neonates and children.
- Adrenocorticotropin stimulation tests are indicated for shock patients unresponsive to standard treatment.
- Further randomized trials are needed to confirm benefits of glucocorticoid replacement therapy.
Purpose Of Review:
Adrenal insufficiency, common in critically ill patients of all ages, has recently gained prominence as a significant pathologic entity in pediatrics. This review describes the current diagnostic approach to detecting adrenal insufficiency and the clinical consequences in critically ill children and infants. It also discusses the current therapeutic approach to adrenal insufficiency in critically ill patients.
Recent Findings:
Relative adrenal insufficiency and its clinical implications have recently come into focus with observational studies demonstrating a high prevalence in pediatric septic shock patients and a significant associated morbidity. Neonatal studies have clarified diagnostic testing and defined clinical outcomes associated with adrenal insufficiency in preterm infants. Comparisons of bioavailable and total cortisol levels demonstrate the utility of total cortisol testing in pediatric septic shock patients.
Summary:
Adrenal insufficiency contributes to morbidity in critically ill neonates and children. Diagnostic testing by adrenocorticotropin stimulation tests should be done in patients unresponsive to standard treatment of shock. Prospective, randomized clinical trials in critically ill neonates and children with adrenal insufficiency are required to determine if these populations will benefit from glucocorticoid replacement therapy.
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