Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication. | ||||||||
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Adrenal response in children with septic shock.Casartelli CH, Garcia PC, Branco RG, Piva JP, Einloft PR, Tasker RC Department of Pediatrics, Division of Pediatric Intensive at Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul, Av Ipiranga 6690, 90610-000, Porto Alegre, Brazil. OBJECTIVE: To describe the serum cortisol profile and evaluate the adrenal response in children with septic shock, and determine the influence of these factors on the outcome and mortality in this group. METHODS: Between May and November 2003, 22 children with septic shock admitted to two pediatric intensive care units in southern Brazil were followed. Adrenal function was evaluated based on the levels of cortisol measured on the occasion of the diagnosis of septic shock and on the response of serum cortisol 30[Symbol: see text]min after the administration of intravenous corticotrophin (0.5[Symbol: see text]mug/1.73[Symbol: see text]m(2)). Adrenal insufficiency was defined as a baseline serum cortisol below 690[Symbol: see text]nmol/l and/or a cortisol response to corticotrophin less than 250[Symbol: see text]nmol/l. RESULTS: Adrenal insufficiency was detected in 17 patients (77.3%). All patients who died had baseline cortisol higher than 690[Symbol: see text]nmol/l. A cortisol response to corticotrophin less than 250[Symbol: see text]nmol/l was associated with a 60% mortality (RR[Symbol: see text]=[Symbol: see text]7.2, 1.03-50.28). Regression analysis showed that the combination of baseline cortisol higher than 690[Symbol: see text]nmol/l and a cortisol response to corticotrophin less than 250[Symbol: see text]nmol/l were associated with mortality after correction for gender and PRISM. CONCLUSIONS: Adrenal insufficiency is a frequent finding in children with septic shock. The low-dose corticotrophin stimulation test seems to be an important tool to distinguish between a normal cortisol response to stress and evidence of adrenal failure. Mortality was significantly higher in children that failed to respond to a corticotrophin stimulation test. Published 23 August 2007 in Intensive Care Med, 33(9): 1609-13.
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