Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1S 3H2 Canada.
Am J Respir Crit Care Med. 2010 Jul 15;182(2):246-51. doi: 10.1164/rccm.200911-1738OC. Epub 2010 Mar 18.
Adrenal insufficiency is a clinical condition associated with fluid- and catecholamine-resistant hypotension.
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.
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 microg) were performed and adrenocorticotropic hormone levels measured in all participants.
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 microg/dl vs. 16.7 microg/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.
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.
肾上腺功能不全是一种与液体和儿茶酚胺抵抗性低血压相关的临床病症。
本研究旨在确定危重病儿童中肾上腺功能不全的患病率、发病的危险因素和潜在机制及其与临床重要结局的关系。
2005 年至 2008 年，在加拿大的 7 个三级儿童重症监护病房进行了一项前瞻性队列研究，纳入了有现有血管通路的 17 岁以下的患者。对所有参与者均进行促肾上腺皮质激素刺激试验（1μg）和促肾上腺皮质激素水平检测。
共有 381 例患者在入院时进行了肾上腺检查。肾上腺功能不全的患病率为 30.2%（95%置信区间，25.9%-35.1%）。与无肾上腺功能不全的患者相比，肾上腺功能不全患者的基础皮质醇水平更高（28.6μg/dl 比 16.7μg/dl，P<0.001），年龄也更大（11.5 岁比 2.3 岁，P<0.001）。肾上腺功能不全与儿茶酚胺需求增加（P<0.001）和更多液体冲击量（P=0.026）相关。小剂量促肾上腺皮质激素刺激试验的敏感性和特异性分别为 100%和 84%。
肾上腺功能不全在危重病儿童的多种疾病中都很常见，与儿茶酚胺和液体冲击量的使用增加相关。其病因可能是多因素的，与基础皮质醇水平升高有关。在提出任何治疗建议之前，有必要进一步研究哪些这些危重病儿童确实存在皮质醇缺乏。
