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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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
Summary
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.
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