Insuficiência adrenal na criança com choque séptico

Abstract

Objective: To review the criteria for diagnosing and treating adrenal insufficiency in patients with septic shock. Sources of data:Articles published in Brazilian and foreign journals selected through these publications' websites and Medline, as well as references cited in key articles Summary of the findings:The literature reports a range betwen 17 and 54 % for the finding of adrenal insufficiency in patients with septic shock. There is no consensus for diagnosing adrenal insufficiency in patients suffering from critical diseases, particularly in patients with septic shock. The presence of volumerefractory and catecholamine-resistant septic shock suggests this condition, while basal cortisol under 25 µg/dl is a diagnostic criterion indicating adrenal insufficiency. The adrenal stimulation test is a useful resource for identifying patients with relative adrenal insufficiency. Our testing option for adrenal stimulation in children is the use of corticotropin in low doses (0.5 µg/1,73 m²). An increase of less than 9 µg/dl in the value of postcorticotropin-stimulated cortisol suggests the presence of occult (relative) adrenal insufficiency. In patients with septic shock presenting adrenal insufficiency, either suspected or confirmed, the administration of hydrocortisone in shock or stress doses can be vital for a favorable clinical outcome. Conclusions:The existing data, although controversial, already provides a basis to determine when to begin hormone replacement therapy, the serum level of cortisol accepted as adequate, and the choice of corticotropin doses for performing the adrenal stimulation test and diagnosing occult or relative adrenal insufficiency in patients with septic shock. J Pediatr (Rio J) 2003;79(Suppl 2):S169-S76: Sepsis, septic shock, adrenal cortex, adrenal gland hypofunction, glucocorticoids, adrenal cortex function tests.

Adrenal function in sepsis and septic shock

“…Esses estudos têm encontrado uma alta incidência de função adrenal inadequada e uma forte associação com a refratariedade do choque às catecolaminas [8][9][10][11] . Porém, muitas questões ainda precisam ser esclarecidas em relação à presença de insuficiência adrenal na sepse e cho- 13,15 .…”

Função adrenal na sepse e choque séptico

“…Such studies have found a high incidence of inadequate adrenal function and a strong association with catecholamine refractory shock. [8][9][10][11] However, many questions still have to be explained regarding presence of adrenal insufficiency in sepsis and septic shock. Based on those questions, we felt encouraged to perform this study to review diagnostic criteria and treatment of adrenal insufficiency in pediatric patients with severe sepsis and septic shock.…”