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The effects of three specific conditions related to critical care on adrenal function in children
Gülay Karagüzel1, Süleyman Atay, Orhan Değer
1Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey. gulkarag@hotmail.com
Insights
Critical care conditions like sepsis and surgery can lead to adrenal insufficiency (AI) in children. However, most patients show significant recovery within two weeks, with sepsis not increasing AI risk.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Adrenal function assessment
Background:
- Critical illness and major surgery can impact endocrine function in children.
- Adrenal insufficiency (AI) is a potential complication in critically ill pediatric patients.
- Understanding adrenal function is crucial for managing pediatric critical care.
Purpose of the Study:
- To investigate the effects of acute critical illness (ACI), sepsis, and major surgery on adrenal function in children.
- To assess serum cortisol, corticotropin (ACTH), dehydroepiandrosterone sulfate, and cytokine levels.
- To evaluate the incidence and recovery of AI in these pediatric populations.
Main Methods:
- A cohort of 74 children was divided into three groups: ACI with sepsis, ACI without sepsis, and major surgery.
- Baseline hormone levels and low-dose ACTH stimulation tests (LD-ST) were performed.
- Serial measurements of ACTH and cortisol were taken, with repeated LD-ST on day 14.
Main Results:
- Adrenal insufficiency (AI) was diagnosed in a significant proportion of patients across all three groups.
- Higher baseline cortisol, ACTH, and dehydroepiandrosterone sulfate levels were observed in patients with AI.
- An 82% recovery rate of AI was noted within two weeks, with patient age and IL-10 levels as predictors.
Conclusions:
- A considerable number of critically ill children develop AI, but most recover spontaneously within two weeks.
- Sepsis was not found to be an independent risk factor for developing AI in this cohort.
- The study provides reference values for serial cortisol and ACTH levels in pediatric critical care settings.
Purpose:
To evaluate the effects of three specific conditions related to critical care on adrenal function with special regard to the levels of serum cortisol, corticotropin (ACTH), dehydroepiandrosterone sulfate, and cytokines.
Methods:
The study enrolled a total of 74 children who were divided into three groups. Group 1 comprised 23 patients who had acute critical illness (ACI) associated with severe sepsis/septic shock. Group 2 comprised 27 patients who had ACI without sepsis. Group 3 comprised 24 patients who underwent major surgery. Blood samples were obtained for baseline measurements and a low-dose ACTH stimulation test (LD-ST) was performed. Serial ACTH and cortisol levels were measured with an interval of 3 days and LD-ST was repeated on day 14 for all groups.
Results:
Baseline cortisol, ACTH, and dehydroepiandrosterone sulfate levels were significantly higher in patients with adrenal insufficiency (AI) than those of without AI. AI was detected in four patients in group 1, seven in group 2, and ten in group 3. Consecutive cortisol and ACTH levels did not differ significantly among the groups. On day 14, the recovery rate in patients with AI was 82 % in the whole group. Patient's age and interleukin-10 level were found to be independent predictors of AI.
Conclusions:
A considerable proportion of patients in these three groups had AI with a high spontaneous recovery rate in 2 weeks. The presence of sepsis was not associated with an increased risk of AI. Our serial cortisol and ACTH values in these different groups could be used as reference values for further studies.
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