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A prospective multicenter study of adrenal function in critically ill children

Kusum Menon1, Roxanne E Ward, Margaret L Lawson

  • 1Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1S 3H2 Canada. menon@cheo.on.ca

American Journal of Respiratory and Critical Care Medicine
|March 20, 2010
PubMed

Insights

Adrenal insufficiency affects 30.2% of critically ill children, requiring more catecholamines and fluids. Further research is needed to identify true cortisol deficiency in these pediatric patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pediatric Endocrinology

Background:

  • Adrenal insufficiency is a critical condition characterized by hypotension resistant to fluids and catecholamines in critically ill children.
  • Understanding its prevalence and impact is crucial for effective management.

Purpose of the Study:

  • To determine the prevalence of adrenal insufficiency in critically ill children.
  • To identify risk factors, potential mechanisms, and associations with clinical outcomes.
  • To evaluate the utility of adrenocorticotropic hormone stimulation tests.

Main Methods:

  • A prospective cohort study involving 381 critically ill children (up to 17 years) in Canadian pediatric intensive care units.
  • Adrenocorticotropic hormone (ACTH) stimulation tests (1 microg) and baseline ACTH levels were measured.
  • Data collected from 2005 to 2008.

Main Results:

  • The prevalence of adrenal insufficiency was 30.2% (95% CI, 25.9-35.1).
  • Patients with adrenal insufficiency were older and had higher baseline cortisol levels (28.6 microg/dl vs. 16.7 microg/dl).
  • Adrenal insufficiency correlated with increased catecholamine use (P < 0.001) and fluid boluses (P = 0.026).

Conclusions:

  • Adrenal insufficiency is common in critically ill children, associated with increased catecholamine and fluid requirements.
  • The etiology is likely multifactorial, with high baseline cortisol levels observed.
  • Further research is essential to define true cortisol deficiency and guide treatment strategies.
Abstract

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