Adrenal dysfunction in critically ill children

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Hormone Physiology

Background:

• Cortisol, a key glucocorticoid, is regulated by the hypothalamic-pituitary axis.
• Critical illness disrupts this axis, increasing corticotrophin-releasing hormone and corticotrophin, while decreasing negative feedback.
• Adrenal insufficiency (AI) in critically ill children is defined by an inadequate cortisol response to ACTH stimulation.

Purpose of the Study:

• To review the current understanding of adrenal insufficiency in critically ill children.
• To highlight the prevalence and diagnostic challenges of AI in this population.
• To underscore the need for a consensus on AI management in pediatric critical care.

Main Methods:

• Review of existing pediatric studies on AI during critical illness.
• Analysis of AI prevalence in septic versus non-septic critically ill children.
• Examination of diagnostic criteria and treatment approaches for pediatric AI.

Main Results:

• Clinically apparent AI is uncommon, but the incidence varies widely based on underlying conditions and diagnostic definitions.
• While sepsis-associated mechanisms are implicated, recent studies suggest AI is prevalent in both septic and non-septic critically ill children.
• The prevalence of AI did not significantly differ between septic and non-septic pediatric patients.

Conclusions:

• Adrenal insufficiency is a noteworthy condition in critically ill children, irrespective of sepsis.
• A multidisciplinary approach is essential for managing pediatric AI.
• A lack of consensus among pediatric intensivists and endocrinologists hinders standardized diagnosis and treatment of AI in pediatric critical illness.