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[Adrenal insufficiency in children with septic shock].
- Source :
-
Jornal de pediatria [J Pediatr (Rio J)] 2003 Nov; Vol. 79 Suppl 2, pp. S169-76. - Publication Year :
- 2003
-
Abstract
- Objective: To review the criteria for diagnosing and treating adrenal insufficiency in patients with septic shock.<br />Source of Data: Articles published in Brazilian and foreign journals selected through these publicationÅ› websites and Medline, as well as references cited in key articles.<br />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 volume-refractory and catecholamine-resistant septic shock suggests this condition, while basal cortisol under 25 micro g/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 micro g/1,73 m(2)). An increase of less than 9 micro g/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.<br />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.
- Subjects :
- Adrenal Cortex Function Tests
Adrenal Insufficiency drug therapy
Adrenal Insufficiency etiology
Adrenocorticotropic Hormone
Anti-Inflammatory Agents therapeutic use
Child
Humans
Hydrocortisone blood
Hydrocortisone therapeutic use
Hypothalamo-Hypophyseal System
Pituitary-Adrenal System
Sensitivity and Specificity
Shock, Septic drug therapy
Adrenal Insufficiency diagnosis
Shock, Septic complications
Subjects
Details
- Language :
- Portuguese
- ISSN :
- 0021-7557
- Volume :
- 79 Suppl 2
- Database :
- MEDLINE
- Journal :
- Jornal de pediatria
- Publication Type :
- Academic Journal
- Accession number :
- 14647713
- Full Text :
- https://doi.org/10.2223/jped.1093