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Serum cortisol responses in febrile children
1Department of Pediatrics, Madigan Army Medical Center, Tacoma, WA 98431.
The Pediatric Infectious Disease Journal
|January 1, 1989
Summary
Children with serious febrile illnesses like pneumonia or meningitis show a larger adrenocortical stress response than previously thought. Current hydrocortisone dosage recommendations may be insufficient for these conditions, potentially requiring higher doses.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Stress Physiology
Background:
- The adrenocortical stress response is crucial for children, especially those with adrenal insufficiency.
- Febrile illnesses can significantly impact this response, but the extent varies with illness severity and type.
Purpose of the Study:
- To prospectively evaluate the adrenocortical stress response in children with various febrile illnesses.
- To determine if current hydrocortisone dosage recommendations are adequate for different types of infections.
Main Methods:
- Prospective evaluation of 76 pediatric patients with fever >101°F.
- Measurement of serum cortisol concentrations at presentation and post-recovery.
Main Results:
- A mean cortisol increase of 3.6-fold was observed.
- Cortisol response magnitude varied significantly by clinical diagnosis, not temperature height.
- Pneumonia, bacterial meningitis, and fever of undetermined origin showed the largest responses (5-fold).
Conclusions:
- Standard hydrocortisone dose adjustments may be inadequate for severe febrile illnesses in children with adrenal insufficiency.
- Higher stress-induced cortisol increases in conditions like pneumonia and meningitis suggest a need for potentially greater hydrocortisone dosage adjustments (4- to 5-fold).