Endocrine Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Biomarker Research

Background:

• Endocrine dysfunction is prevalent in critically ill children, affecting glucose, thyroid, and cortisol metabolism.
• Standardized diagnostic criteria are needed for accurate assessment and management.

Purpose of the Study:

• To establish consensus criteria for endocrine dysfunction in critically ill children.
• To correlate specific biomarkers with clinical and functional outcomes in this population.

Main Methods:

• Systematic review of PubMed and Embase databases (1992-2020).
• Inclusion of studies on critically ill children with endocrine abnormalities and relevant outcomes.
• Exclusion of adult studies, premature infants, animals, reviews, and small case series.

Main Results:

• Proposed criteria for abnormal glucose homeostasis: blood glucose >150 mg/dL or <50 mg/dL.
• Proposed criteria for abnormal thyroid function: serum total thyroxine <4.2 μg/dL.
• Proposed criteria for abnormal adrenal function: peak serum cortisol <18 μg/dL and/or increment <9 μg/dL post-ACTH stimulation.

Conclusions:

• Consensus criteria for endocrine dysfunction in critically ill children are presented.
• Criteria encompass specific measures for blood glucose, total thyroxine, and adrenal axis testing.
• Addresses limitations such as variable sampling and inconsistent interpretation of tests.