Dynamics of endogenous glucocorticoid secretion and its metabolism in Kawasaki disease

Abstract

Decreases in cortisol levels and the cortisol/cortisone ratio before the first IVIG may be explained by a reduction in adrenal secretion and/or local glucocorticoid action through 11beta-HSD activity. These findings suggest that exogenous glucocorticoid treatment in combination with the first IVIG at the acute stage may play a synergetic role in KD.

High incidence of adrenal suppression in children with Kawasaki disease treated with intravenous immunoglobulin plus prednisolone

“…Sano et al measured serum cortisol values in patients with KD repeatedly during the course of IVIG treatment. They reported that mean morning cortisol values of the patients at convalescence after IVIG treatment was about 10 µg/dL [25], suggesting their patients' adrenal function was reserved.…”

Changes in 11β-Hydroxysteroid Dehydrogenase and Glucocorticoid Receptor Expression in Kawasaki Disease

“…Studies have shown that the serum cortisol/cortisone ratio might reflect the activity of this enzymatic reaction. Sano et al17) found that the serum cortisol and cortisone levels in KD children on admission and after the first dose of IVIG therapy were significantly higher than those in the disease recovery stage. This suggests that 11β-HSD1 activity in KD patients is upregulated and that this upregulation decreases in a time-dependent manner via the reduction of adrenal gland secretion and/or the reduction of 11β-HSD activity, which decreases endogenous cortisol levels.…”

Kawasaki Disease, Others Heart Injuries, Not Only Coronary Arteritis

“…The most utilized treatment is the application of Intravenous gammaglobulin (GGIV) at a dose of 2 per kg in a sole dose for a 12-infusion; this is the most accepted treatment and has allowed to the reduction of prevalence of aneurysms to <5% and a mortality of 2% to 0.3%, although the GGIV scheme is at a dosage of 400 mg × kg × day for 5 days, plus aspirin at 80 to 100 mg × kg × day. According to response, the GGIV dose can be repeated, or corticoids can be added, especially in refractory cases (Cha, 2008;Chung, 2009;Falcini, 2006;Hung, 2009;Miura, 2008;Newbauer, 2004;Ogata, 2009;Okada, 2009;Sano, 2010;Tremoulet, 2008).…”