Thyroid function and stress hormones in children with stress hyperglycemia

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Metabolic Disorders

Background:

• Stress hyperglycemia is a common metabolic response in critically ill patients.
• Understanding its prevalence and hormonal changes in children is crucial for effective management.
• Previous research has not fully elucidated the role of thyroid and stress hormones in pediatric stress hyperglycemia.

Purpose of the Study:

• To determine the prevalence of stress hyperglycemia in children admitted to pediatric emergency wards.
• To investigate alterations in thyroid and stress hormones during stress hyperglycemia in this pediatric population.

Main Methods:

• A prospective cross-sectional study involving 1,054 children under 19 years old admitted to emergency wards.
• Exclusion criteria included steroid/beta-agonist use, glucose administration, pre-existing diabetes mellitus, or thyroid disease.
• Blood glucose levels were measured; stress hormones (cortisol, insulin, growth hormone, prolactin) and thyroid function (T3, T4) were assessed in cases (blood glucose ≥ 150 mg/dL) and age/sex-matched controls.

Main Results:

• Stress hyperglycemia was identified in 3.7% (39/1,054) of screened children, predominantly those under 6 years old.
• A positive family history of diabetes mellitus was associated with a higher incidence of hyperglycemia (odds ratio = 3.2).
• Cases showed significantly higher cortisol and lower total T3 and T4 levels compared to controls; other measured hormones did not differ significantly.

Conclusions:

• Stress hyperglycemia is an occasional finding in critically ill children, with elevated cortisol being a key hormonal change.
• The study found no significant differences in thyroid hormones between cases and controls, except for lower T3 and T4 in cases.
• Stress hyperglycemia in children does not appear to be a significant risk factor for developing diabetes within a 24-month follow-up period.