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Urinary free cortisol values in children under stress
The Journal of Pediatrics
|December 1, 1994
Summary
Current glucocorticoid dose recommendations for stressed children may be insufficient. Studies show urinary free cortisol (UFC) increases significantly during severe illness or trauma, potentially exceeding current dosage guidelines for pediatric adrenocortical insufficiency.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Biochemistry
Background:
- Children with adrenocortical insufficiency typically require 3-5x glucocorticoid dose increases during stress.
- The accuracy of these recommendations during significant physiological stress is not well-established.
- Urinary free cortisol (UFC) is a key indicator of endogenous glucocorticoid production.
Purpose of the Study:
- To evaluate if current glucocorticoid replacement guidelines reflect actual UFC changes in stressed children.
- To assess UFC excretion patterns in pediatric patients experiencing critical illness, surgery, or infection.
Main Methods:
- Measured 24-hour UFC excretion in 78 pediatric patients admitted for severe illness or surgery.
- Re-evaluated 43 patients post-recovery.
- Compared UFC levels with 127 healthy children and analyzed correlations with age, creatinine, and body surface area.
Main Results:
- UFC levels correlated positively with age, but UFC per surface area was age-independent.
- Greatest UFC increases per square meter surface area were observed in children undergoing cardiothoracic surgery and those with multiple trauma.
- Bacterial infections led to significantly higher UFC increases than viral infections.
Conclusions:
- Current 3-5x glucocorticoid dose increase recommendations may underestimate needs for children with major surgery, trauma, or severe bacterial infections.
- Further production rate studies are necessary to refine stress-related glucocorticoid dosing in pediatric patients.
- UFC monitoring offers insights into the physiological stress response in children.