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Critical illness-related corticosteroid insufficiency (CIRCI) in paediatric patients: a diagnostic and therapeutic

Letteria Anna Morabito1, Domenico Corica2,3, Giorgia Pepe2,3

  • 1Pediatric Unit, Maternal Infant Department, "Gaetano Martino" University Hospital, Via Consolare Valeria, 98122, Messina, Italy. letteria.morabito@gmail.com.

Italian Journal of Pediatrics
|March 11, 2024
PubMed

Insights

Critical illness-related corticosteroid insufficiency (CIRCI) is a dangerous HPA axis dysfunction in ICU patients, linked to inflammation and higher mortality. This review clarifies CIRCI diagnosis and treatment in children.

Area of Science:

  • Pediatric critical care medicine
  • Pediatric endocrinology
  • Intensive care unit (ICU) management

Background:

  • Critical illness-related corticosteroid insufficiency (CIRCI) is a life-threatening dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis in ICU patients.
  • CIRCI is associated with increased inflammation, coagulation markers, morbidity, prolonged ICU stays, and mortality.
  • Pathogenesis involves reduced CRH-stimulated ACTH release, glucocorticoid resistance, and altered cortisol metabolism.

Purpose of the Study:

  • To define CIRCI in pediatric patients.
  • To provide guidance on diagnosing and treating CIRCI in children based on current literature.
  • To address the ongoing debate regarding diagnostic criteria and prevalence in pediatric age groups.

Main Methods:

  • Narrative review of current literature.
  • Focus on defining CIRCI in the pediatric population.
  • Synthesis of data to advise on diagnosis and treatment strategies.

Main Results:

  • The definition and management of CIRCI in children remain debated among specialists.
  • Lack of consensus on diagnostic criteria and prevalence in pediatric intensive care.
  • Current literature provides a basis for understanding and managing pediatric CIRCI.

Conclusions:

  • CIRCI presents a significant challenge in pediatric critical care.
  • Standardized diagnostic criteria and treatment protocols for pediatric CIRCI are needed.
  • Further research and consensus among specialists are crucial for optimal patient outcomes.

Keywords:
Adrenal insufficiencyCritical illness related corticosteroid insufficiencyPaediatric critical care

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