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[Evaluation of adrenocortical function in children with severe and critical enterovirus 71 infection]

Jie Wu1, Yi-bing Cheng, Zhi-fang Li

  • 1Department of Emergency Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.

Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics
|July 18, 2012
PubMed

Insights

Adrenal insufficiency (AI) is common in children with severe enterovirus 71 infection, particularly in critical cases. Early identification and potential glucocorticoid treatment are crucial for improving outcomes in these pediatric patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Endocrinology
  • Critical Care Medicine

Background:

  • Enterovirus 71 (EV71) infection can lead to severe and critical illness in children.
  • Adrenocortical function is not well understood in pediatric EV71 infections.
  • Hand-foot-and-mouth disease (HFMD) caused by EV71 can have severe complications.

Purpose of the Study:

  • To evaluate adrenocortical function in children with severe and critical EV71 infection.
  • To assess the utility of a high-dose (250 µg) adrenocorticotropic hormone (ACTH) stimulation test.
  • To provide an experimental basis for considering glucocorticoid therapy in EV71-related HFMD.

Main Methods:

  • Prospective multi-center study in Pediatric Intensive Care Units (PICUs).
  • Enrolled 51 children with severe/critical EV71 infection confirmed by nucleic acid testing.
  • Administered a 250 µg ACTH stimulation test, measuring cortisol at baseline (T0) and 30/60 minutes (T30/T60) before glucocorticoid administration. Adrenal insufficiency (AI) defined as ΔTmax ≤ 9 µg/dl.

Main Results:

  • The overall incidence of AI was 52.94% (27/51).
  • AI incidence was significantly higher in the critical group (76.92%) compared to the severe group (44.74%).
  • Higher AI incidence was observed in patients with lower Pediatric Critical Illness Scores (PCIS ≤ 70).

Conclusions:

  • Adrenal insufficiency is prevalent in children with EV71 infection, especially in critical cases.
  • AI may impact the prognosis of severe and critical EV71 infections.
  • Consideration of exogenous glucocorticoids for identified or suspected AI is warranted, pending further research on optimal timing, dosage, and regimen.
Abstract

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