Bone Mark, Diver Michael, Selby Andrew, Sharples Andrew, Addison Michael, Clayton Peter
Academic Unit of Child Health, Royal Manchester Children's Hospital, Department of Clinical Biochemistry, Manchester, United Kingdom.
Pediatrics. 2002 Sep;110(3):563-9. doi: 10.1542/peds.110.3.563.
To determine the status of the hypothalamic-pituitary-adrenal axis in children who had meningococcal disease and were admitted to 2 regional pediatric intensive care units.
Sixty-five children (34 boys; median age: 2.5 years; range: 0.2-15 years) had cortisol and adrenocorticotropic hormone (ACTH) levels measured on admission, then at 8 AM and 8 PM during the next 48 hours. At 48 hours, a low-dose short Synacthen test (LDST) (500 ng of 1-24 corticotropin/m2) was performed in 42 patients (19 boys). Normal ranges for 8 AM cortisol and ACTH levels in unstressed children were 140 to 500 nmol/L and 2 to 11.3 pmol/L, respectively. Adrenal insufficiency (AI) was defined as a peak cortisol <500 nmol/L on the LDST or an 8 AM cortisol value <140 nmol/L.
Five (7.7%) of the 65 children died, including 1 with primary AI. Cortisol levels were elevated on admission (median: 1122 mmol/L; range: 65-2110 nmol/L) with 81% of values more than the 8 AM normal range. The median ACTH level on admission was within the 8 AM normal range, but 40% of values were more than the 8 AM normal range. However, 7% and 8% of cortisol and ACTH values, respectively, were less than the normal range. Both cortisol and ACTH levels fell thereafter and showed no diurnal variation during the 48-hour profile. Six (14%) of the 42 failed the LDST. These patients had significantly lower mean 8 AM cortisol values than those with a normal peak value on the LDST. Five additional patients who did not have the LDST had 8 AM cortisol values <140 nmol/L. In the diagnosis of AI, the sensitivity of the 8 AM mean cortisol value at a cutoff of 400 nmol/L, judged against the LDST, was 83%; the specificity was 81%.
During the initial phase of meningococcal disease, raised cortisol and ACTH levels indicate an appropriate stress response within the hypothalamic-pituitary-adrenal axis. However, a substantial subpopulation (11 [16.9%] of 65) has evidence of adrenal dysfunction during this period. Morning cortisol values in the initial phase of meningococcal disease could be used as a potential early index of AI.
确定患脑膜炎球菌病并入住2个地区儿科重症监护病房的儿童下丘脑-垂体-肾上腺轴的状态。
65名儿童（34名男孩；中位年龄：2.5岁；范围：0.2 - 15岁）在入院时、接下来48小时内的上午8点和晚上8点测量皮质醇和促肾上腺皮质激素（ACTH）水平。48小时时，对42例患者（19名男孩）进行低剂量短程促肾上腺皮质激素试验（LDST）（500 ng的1 - 24促肾上腺皮质激素/m²）。无应激儿童上午8点皮质醇和ACTH水平的正常范围分别为140至500 nmol/L和2至11.3 pmol/L。肾上腺功能不全（AI）定义为LDST时皮质醇峰值<500 nmol/L或上午8点皮质醇值<140 nmol/L。
65名儿童中有5名（7.7%）死亡，其中1名患有原发性AI。入院时皮质醇水平升高（中位值：1122 mmol/L；范围：65 - 2110 nmol/L），81%的值高于上午8点正常范围。入院时ACTH水平中位数在上午8点正常范围内，但40%的值高于上午8点正常范围。然而，分别有7%和8%的皮质醇和ACTH值低于正常范围。此后皮质醇和ACTH水平均下降，在48小时监测期间无昼夜变化。42例中6例（14%）LDST未通过。这些患者上午8点的平均皮质醇值显著低于LDST峰值正常的患者。另外5例未进行LDST的患者上午8点皮质醇值<140 nmol/L。在AI诊断中，以LDST为对照，上午8点平均皮质醇值截断值为400 nmol/L时的敏感性为83%；特异性为81%。
在脑膜炎球菌病的初始阶段，皮质醇和ACTH水平升高表明下丘脑-垂体-肾上腺轴内有适当的应激反应。然而，在此期间有相当一部分人群（65名中的11名[16.9%]）有肾上腺功能障碍的证据。脑膜炎球菌病初始阶段的早晨皮质醇值可作为AI的潜在早期指标。
