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The relationship between vitamin D status and adrenal insufficiency in critically ill children

J Dayre McNally1, Dermot R Doherty, Margaret L Lawson

  • 1Department of Pediatrics, Faculty of Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada. dmcnally@cheo.on.ca

The Journal of Clinical Endocrinology and Metabolism
|April 3, 2013
PubMed

Insights

Vitamin D deficiency may worsen adrenal insufficiency (AI) in critically ill children, increasing their risk of cardiovascular dysfunction. This study found no direct link between vitamin D levels and AI itself.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Nutritional Science

Background:

  • Adrenal insufficiency (AI) and vitamin D deficiency are linked to poor outcomes in critically ill patients.
  • Potential synergistic mechanisms between these hormones in critical illness warrant investigation.

Purpose of the Study:

  • To explore relationships between vitamin D status, adrenal function, and cardiovascular dysfunction in critically ill children.
  • To determine if vitamin D deficiency modifies the impact of AI on cardiovascular stability.

Main Methods:

  • Secondary analysis of a prospective cohort study involving 319 critically ill children.
  • Vitamin D status assessed via 25-hydroxyvitamin D (25OHD) levels.
  • AI defined by cortisol response to cosyntropin; cardiovascular dysfunction by catecholamine requirement.

Main Results:

  • No direct association found between vitamin D status and AI in critically ill children.
  • Vitamin D deficiency significantly increased the odds of catecholamine use in children with AI (OR 5.29) compared to those with sufficient vitamin D (OR 1.63).
  • Linear regression showed no relationship between 25OHD levels and baseline or post-cosyntropin cortisol.

Conclusions:

  • The study did not find evidence of a direct link between vitamin D status and AI in critical illness.
  • Vitamin D deficiency appears to exacerbate the negative impact of AI on cardiovascular stability in critically ill children.
Abstract

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