Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey.
Intensive Care Med. 2012 Oct;38(10):1689-96. doi: 10.1007/s00134-012-2662-5. Epub 2012 Aug 10.
To evaluate the effects of three specific conditions related to critical care on adrenal function with special regard to the levels of serum cortisol, corticotropin (ACTH), dehydroepiandrosterone sulfate, and cytokines.
The study enrolled a total of 74 children who were divided into three groups. Group 1 comprised 23 patients who had acute critical illness (ACI) associated with severe sepsis/septic shock. Group 2 comprised 27 patients who had ACI without sepsis. Group 3 comprised 24 patients who underwent major surgery. Blood samples were obtained for baseline measurements and a low-dose ACTH stimulation test (LD-ST) was performed. Serial ACTH and cortisol levels were measured with an interval of 3 days and LD-ST was repeated on day 14 for all groups.
Baseline cortisol, ACTH, and dehydroepiandrosterone sulfate levels were significantly higher in patients with adrenal insufficiency (AI) than those of without AI. AI was detected in four patients in group 1, seven in group 2, and ten in group 3. Consecutive cortisol and ACTH levels did not differ significantly among the groups. On day 14, the recovery rate in patients with AI was 82 % in the whole group. Patient's age and interleukin-10 level were found to be independent predictors of AI.
A considerable proportion of patients in these three groups had AI with a high spontaneous recovery rate in 2 weeks. The presence of sepsis was not associated with an increased risk of AI. Our serial cortisol and ACTH values in these different groups could be used as reference values for further studies.
评估与重症监护相关的三种特定条件对肾上腺功能的影响，特别关注血清皮质醇、促肾上腺皮质激素（ACTH）、硫酸脱氢表雄酮和细胞因子的水平。
本研究共纳入 74 名儿童，分为三组。第 1 组 23 例为伴有严重脓毒症/感染性休克的急性危重病（ACI）患儿；第 2 组 27 例为无脓毒症的 ACI 患儿；第 3 组 24 例为接受大手术的患儿。采集血样进行基线测量，并对所有组进行小剂量 ACTH 刺激试验（LD-ST）。第 3 天间隔测量连续的 ACTH 和皮质醇水平，所有组均在第 14 天重复 LD-ST。
与无肾上腺功能不全（AI）的患儿相比，有 AI 的患儿的基础皮质醇、ACTH 和硫酸脱氢表雄酮水平明显更高。第 1 组中 4 例、第 2 组中 7 例和第 3 组中 10 例检测到 AI。各组间连续皮质醇和 ACTH 水平无显著差异。第 14 天，AI 患者的整体恢复率为 82%。患者年龄和白介素-10 水平是 AI 的独立预测因素。
这三组中有相当比例的患者存在 AI，且 2 周内有较高的自发恢复率。脓毒症的存在与 AI 风险的增加无关。我们在这些不同组中的连续皮质醇和 ACTH 值可作为进一步研究的参考值。
