Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?

Riordan, F. A. I.; Thomson, A. P. J.; Ratcliffe, Jane; Sills, J. A.; Diver, M. J.; Hart, C. A.

doi:10.1097/00003246-199910000-00032

Cited by 99 publications

(61 citation statements)

References 32 publications

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“…Two recent randomized controlled trials in adults on the use of steroids in suspected adrenal insufficiency showed conflicting results (12,13), further adding to the controversy. We identified only a few small observational studies (ranging from 13-72 patients; see Table E1 in the online supplement) examining adrenal insufficiency in pediatric critical illness (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). These pediatric studies used multiple different definitions for the diagnosis of adrenal insufficiency, focused almost exclusively on patients with septic shock (17,19,20,22,23), did not conduct corticotropin stimulation tests on all patients (only obtained random cortisol levels) (15,16,24), and used different doses for the corticotropin tests.…”

Section: Abstract Adrenal Gland; Adrenal Function; Adrenocorticotropimentioning

confidence: 99%

“…Based on quoted estimates in the literature (14,(16)(17)(18)(20)(21)(22)(23), we assumed a prevalence of 40%; therefore, a sample size of 369 patients permitted an estimate of prevalence to within ± 5%, 19 times out of 20. To allow for a potential dropout rate of 5%, the total sample size was 389.…”

Section: Sample Size and Statistical Analysismentioning

confidence: 99%

“…We identified only a few small observational studies (ranging from 13-72 patients; see Table E1 in the online supplement) examining adrenal insufficiency in pediatric critical illness (14-24). These pediatric studies used multiple different definitions for the diagnosis of adrenal insufficiency, focused almost exclusively on patients with septic shock (17,19,20,22,23), did not conduct corticotropin stimulation tests on all patients (only obtained random cortisol levels) (15,16,24), and used different doses for the corticotropin tests. As a result, the reported prevalence of adrenal insufficiency varies from 10 (16) to 100% (15).…”

mentioning

confidence: 99%

See 2 more Smart Citations

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

Menon

Ward²,

Lawson³

et al. 2010

Am J Respir Crit Care Med

101

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Rationale-Adrenal insufficiency is a clinical condition associated with fluid-and catecholamine-resistant hypotension.Objectives-The objectives of this study were to determine the prevalence of adrenal insufficiency, risk factors and potential mechanisms for its development, and its association with clinically important outcomes in critically ill children.Correspondence and requests for reprints should be addressed to Kusum Menon, M.Sc., Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1S 3H2 Canada. menon@cheo.on.ca. * Canadian Critical Care Trials AIP Study Group: Institutions, site investigators, research coordinators, and research assistants (numbers of enrolled patients are shown in parentheses): British Columbia Children's and Women's Hospital, Vancouver, BC, Canada Conflict of Interest Statement:None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.The CIHR and CHEORI had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation of the manuscript. Assistance in the design of the study was provided by the Canadian Critical Care Trials Group. This article has an online supplement, which is accessible from this issue's CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptMethods-A prospective, cohort study was conducted from 2005 to 2008 in seven tertiary-care, pediatric intensive care units in Canada on patients up to 17 years of age with existing vascular access. Adrenocorticotropic hormone stimulation tests (1 μg) were performed and adrenocorticotropic hormone levels measured in all participants. Measurements and MainResults-A total of 381 patients had adrenal testing on admission. The prevalence of adrenal insufficiency was 30.2% (95% confidence interval, 25.9-35.1). Patients with adrenal insufficiency had higher baseline cortisol levels (28.6 μg/dl vs. 16.7 μg/dl, P < 0.001) and were significantly older (11.5 yr vs. 2.3 yr, P < 0.001) than those without adrenal insufficiency. Adrenal insufficiency was associated with an increased need for catecholamines (P <0.001) and more fluid boluses (P = 0.026). The sensitivity and specificity of the low-dose adrenocorticotropic hormone stimulation test were 100% and 84%, respectively.Conclusions-Adrenal insufficiency occurs in many disease conditions in critically ill children and is associated with an increased use of catecholamines and fluid boluses. It is likely multifactorial in etiology and is associated with high baseline cortisol levels. Further research is necessary to determine which of these critically ill children are truly cortisol deficient before any treatment recommendations can be made. Keywords adrenal gland; adrenal function; adrenocorticotropic hormoneAdrenal insufficiency is a clinical condition associated with hypotension that can be resistant to fluid and catecholamine therapy and, if untreated, can result in increased morta...

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Section: Abstract Adrenal Gland; Adrenal Function; Adrenocorticotropimentioning

confidence: 99%

Section: Sample Size and Statistical Analysismentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

Menon

Ward²,

Lawson³

et al. 2010

Am J Respir Crit Care Med

101

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“…This case mimicked prolactinoma with ACTHoma, since the serum ACTH and cortisol levels were elevated due to meningitis at hospitalization. The serum ACTH titer can increase several fold under normal physiological conditions in response to stress, 11) with a 10-fold increase under intense stress such as during meningitis 9,10,13) or after surgery. 3,12) The serum ACTH titer at hospitalization in our patient was about 7-fold higher compared to the value after the meningitis was cured.…”

Section: Discussionmentioning

confidence: 99%

“…4,8) Meningitis is known to cause increases in the level of serum adrenocorticotropic hormone (ACTH), an adenohypophysial hormone, and the cortisol titer. 9,10,13) Here we describe a case of prolactinoma with a high serum ACTH level caused by meningitis.…”

Section: Introductionmentioning

confidence: 95%

Prolactinoma With a High Adrenocorticotropic Hormone Level Caused by Meningitis-Case Report-

Utsuki

Oka²,

Tanaka

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 69-year-old man was admitted semicomatose with high-grade fever and meningeal signs. Magnetic resonance imaging showed a supra-and intrasellar lesion. Hormone studies on admission showed increased serum prolactin, adrenocorticotropic hormone (ACTH), and cortisol titers. However, the serum ACTH and cortisol levels returned to normal after treatment of meningitis with an antimicrobial agent. The histological diagnosis was pituitary adenoma. Immunohistological staining showed positive reaction for prolactin but not for ACTH. This is a rare case of prolactinoma with a high serum ACTH level caused by meningitis.

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Systemic Sepsis

2007

Evidence‐based Pediatric Infectious Diseases

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Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: Evidence of adrenal insufficiency?

Abstract: Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.

Cited by 99 publications

References 32 publications

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

Prolactinoma With a High Adrenocorticotropic Hormone Level Caused by Meningitis-Case Report-

Systemic Sepsis

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