[Adrenal function evaluation using ACTH stimulation test in children with sepsis and septic shock]

Area of Science:

• Pediatric critical care medicine
• Endocrinology
• Infectious diseases

Context:

• Sepsis and septic shock are major causes of mortality and morbidity in pediatric intensive care units (PICUs).
• While steroid replacement therapy shows benefits in adults with septic shock and relative adrenal insufficiency (RAI), data in children is limited.
• Understanding adrenal insufficiency prevalence in pediatric sepsis is crucial for optimizing treatment.

Purpose:

• To determine the prevalence of adrenal insufficiency in children with sepsis and septic shock.
• To evaluate adrenal function using a low-dose adrenocorticotropic hormone (ACTH) stimulation test (1 microg/1.73 m2).
• To differentiate between absolute adrenal insufficiency (AAI) and relative adrenal insufficiency (RAI).

Summary:

• A prospective study in 62 pediatric patients with sepsis or septic shock used a low-dose ACTH stimulation test.
• Adrenal insufficiency was defined as a cortisol response <= 90 microg/L post-stimulation.
• Overall, 40.3% of patients exhibited adrenal insufficiency, with no significant difference between sepsis and septic shock groups.

Impact:

• The findings indicate that adrenal insufficiency is common in pediatric sepsis and septic shock.
• The low-dose ACTH stimulation test is a viable tool for assessing adrenal function in these critically ill children.
• This evaluation may guide the use of corticosteroid therapy for potential survival benefits in patients with RAI.