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Adrenal function in sepsis and septic shock

Cristiane Freitas Pizarro1, Eduardo Juan Troster

  • 1Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. crispizarro@terra.com.br

Jornal De Pediatria
|November 8, 2007
PubMed

Insights

Adrenal insufficiency is common in pediatric sepsis and septic shock, potentially causing refractory shock. The effectiveness of low-dose steroid therapy in these critically ill children requires further investigation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Infectious Diseases

Background:

  • Adrenal insufficiency is a recognized complication in pediatric patients experiencing severe sepsis and septic shock.
  • This condition may contribute to the development of catecholamine-refractory shock, a severe and life-threatening complication.

Purpose of the Study:

  • To review the diagnostic criteria for adrenal insufficiency in pediatric patients with severe sepsis and septic shock.
  • To examine the current treatment strategies for this condition in the pediatric population.

Main Methods:

  • A literature search was conducted using MEDLINE, Embase, and Cochrane Library databases.
  • Keywords included "septic shock," "sepsis," "corticosteroids," "adrenal insufficiency," and "children."

Main Results:

  • Diagnostic criteria for adrenal insufficiency in critically ill children are not well-established, leading to a wide incidence range (15%-61%).
  • The rapid corticotropin stimulation test is commonly used, with ongoing debate regarding optimal corticotropin dosage (standard 250 microg vs. proposed sensitive 1 microg).
  • The efficacy of low-dose corticosteroids in children with catecholamine-refractory shock remains uncertain, necessitating further research.

Conclusions:

  • Adrenal insufficiency is prevalent in pediatric severe sepsis and septic shock and may be a factor in catecholamine-refractory shock.
  • Further research is needed to clarify the impact of low-dose steroid replacement therapy on morbidity and mortality in these patients.
Abstract

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