Absolute and relative adrenal insufficiency in children with septic shock

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dc.contributor.authorPizarro, C. F.
dc.contributor.authorTroster, E. J.
dc.contributor.authorDamiani, D.
dc.contributor.authorCarcillo, J. A.
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T12:37:47Z
dc.date.available2016-01-24T12:37:47Z
dc.date.issued2005-04-01
dc.description.abstractObjective: Corticosteroid replacement improves outcome in adults with relative adrenal insufficiency and catecholamine-resistant septic shock. We evaluated the relationship of absolute and relative adrenal insufficiency to catecholamine-resistant septic shock in children.Design. Prospective cohort study.Setting. University hospital pediatric intensive care unit in Brazil.Patients. Fifty-seven children with septic shock. Children with HIV infection, those with a history of adrenal insufficiency, and those submitted to any steroid therapy or etomidate within the week before diagnosis of septic shock were excluded.Interventions: None.Measurements and Main Results., A short corticotropin test (250 mu g) was performed, and cortisol levels were measured at baseline and 30 and 60 mins posttest. Adrenal insufficiency was defined by a response <= 9 mu g/dL. Absolute adrenal insufficiency was further defined by a baseline cortisol < 20 mu g/dL and relative adrenal insufficiency by a baseline cortisol > 20 mu g/dL. Absolute adrenal insufficiency was observed in 18% of children, all of whom had catecholamine-resistant shock. Relative adrenal insufficiency was observed in 26% of children, of whom 80% had catecholamine-resistant and 20% had dopamine/dobutamine-responsive shock. All children with fluid-responsive shock had a cortisol response > 9 mu g/dL. Children with adrenal insufficiency had an increased risk of catecholamine-resistant shock (relative risk, 1.88; 95% confidence interval, 1.26-2.79). However, mortality was independently predicted by chronic illness or multiple organ failure (p <.05), not adrenal insufficiency.Conclusions: Absolute and relative adrenal insufficiency is common in children with catecholamine-resistant shock and absent in children with fluid-responsive shock. Studies are warranted to determine whether corticosterold therapy has a survival benefit in children with relative adrenal insufficiency and catecholamine-resistant septic shock.en
dc.description.affiliationUniv São Paulo, Fac Med, Inst Crianca Pedro Alcantra, Dept Pediat,Pediat Intens Care Unit, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent855-859
dc.identifierhttp://dx.doi.org/10.1097/01.CCM.0000159854.23324.84
dc.identifier.citationCritical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 33, n. 4, p. 855-859, 2005.
dc.identifier.doi10.1097/01.CCM.0000159854.23324.84
dc.identifier.issn0090-3493
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/28236
dc.identifier.wosWOS:000228282700024
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofCritical Care Medicine
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectseptic shocken
dc.subjectsepsisen
dc.subjectadrenal insufficiencyen
dc.subjectshocken
dc.subjectcorticosteroidsen
dc.subjectcortisolen
dc.titleAbsolute and relative adrenal insufficiency in children with septic shocken
dc.typeinfo:eu-repo/semantics/article
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