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EVALUATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN A PAEDIATRIC INTENSIVE CARE UNIT

M Demiral1, E Kiral2, E C Dinleyici2

  • 1Eskişehir Osmangazi University, School of Medicine, Paediatric Endocrinology, Eskişehir, Turkey.

Acta Endocrinologica (Bucharest, Romania : 2005)
|May 8, 2020
PubMed

Insights

In critically ill children, high cortisol levels indicate severe illness. Close monitoring is crucial for patients with very high cortisol due to increased mortality risk.

Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Hormone Physiology

Background:

  • Relative adrenal insufficiency (RAI) is characterized by inadequate cortisol production from hypothalamic-pituitary-adrenal (HPA) axis dysfunction during severe illness.
  • Evaluating HPA axis function and RAI is critical in tertiary pediatric intensive care units (PICUs).

Purpose of the Study:

  • To assess the hypothalamic-pituitary-adrenal (HPA) axis function and the prevalence of relative adrenal insufficiency (RAI) in pediatric intensive care unit (PICU) patients.
  • To correlate cortisol levels with disease severity and outcomes in critically ill children.

Main Methods:

  • A prospective cohort study involving 100 PICU patients.
  • Measurement of basal serum adrenocorticotropic hormone (ACTH) and cortisol levels, compared to a control group.
  • Performance of a low-dose ACTH stimulation test for patients with basal cortisol < 18 µg/dL.

Main Results:

  • PICU patients exhibited significantly higher basal cortisol levels than controls (P < 0.05).
  • All stimulated patients (n=24) showed adequate cortisol response (delta > 9 µg/dL, peak > 18 µg/dL).
  • Basal cortisol levels positively correlated with Pediatric Risk of Mortality (PRISM) III scores (P < 0.05; r = 0.363).

Conclusions:

  • Elevated basal or stimulated cortisol levels in the acute stress phase signify disease severity in critically ill children.
  • Patients with markedly high cortisol levels require vigilant monitoring due to a heightened risk of mortality.
Abstract

Keywords:
adrenal insufficiencycortisolcritical illnesspediatric risk of mortality score

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