The evaluation of surrenal gland function using low dose corticotropin test and prognostic factors in children with septic and nonseptic critical ill children

Aims: Our aims to detect the frequency of adrenal insufficiency (AI) using low dose corticotropin (ACTH) test and other endocrine dysfunctions in children with septic and nonseptic critical illness, and to determine the prognostic effects of some biochemical parameters in these patients.Material and Method: A total of 74 children with acute critical illness (ACI) ages between six-month-old and 15-year-old were recruited the study. They were divided into three main groups as septic (Group 1, n:23), nonseptic (Group 2, n:27) and surgical (Group 3, n:24). For different comparisons, subdivisions were also organized. Antropometry, vital findings and disease severity scoring (DSS) were recorded and blood samples were taken for ACTH, cortisol, glucose, calcium (Ca), albumin, procalcitonin (PCT), insulin, dehydroepiandrosterone sulphate (DHEAS), parathyroid hormon (PTH), free T3 (FT3), free T4 (FT4), tyroid stimulating hormon (TSH), ischemia modified albumin (IMA), TNF-?, IL-6 ve IL-10. Furthermore, low dose (1 ?g) ACTH test was done for AI diagnosis. On the 3rd, 7th and 10th days, ACTH and cortisol level and on 14th day ACTH test were repeated. Statistical evaluations were made using SPSS program.Results: The frequency of AI was determined as 30%. Statistically significant difference was not found among the three groups in terms of the levels of successive ACTH and cortisol. Significant difference was found out in ACTH test among 0th, 30th and 60th minute cortisol in Group 1 and Group 2. While in Group 3, only in the 30th minute, significant increase was detected (p<0,05). When the patients with AI were compared with the others, any significant difference was not detected among FT3, FT4, TSH, DHEAS, IMA, PCT, IL-6 ve IL-10. However, there was a significant difference among glucose, Ca and TNF-? levels. There was a significant relation between cortisol levels and DSS. Blood pressure was significantly lower in Group 1, and also fluid and catecholamine refractory shock (FRS, CRS) and multipl organ disfunction sydrome (MODS) were higher. The frequency of nonthyroidal disease was found as 29%. Thyroid hormones were significantly lower in patients with FRS and MODS developing ones. A negative link was found among cortisol level, DSS and thyroid hormones. The frequency of hyperglycemia was 59% and significantly higher in Group 3. A positive correlation was detected among glucose level, DSS and cortisol. Hypocalcemia was observed in 30% of the cases and it was common in cases with MODS, sepsis and fluid replacement. A negative relation was found between Ca level and DSS. However, a positive relation was detected among PTH, DSS and glucose levels. IMA levels didn?t show a significant difference among the three groups. It was also found that the increase in the rate of IMA/albumin reduced AI risk and height in decimal age and IL-10 levels increased AI risk. Moreover, it was also realized that PCT levels were higher in cases with MODS and fluid replacement.Conclusions: The frequency of AI was common in children with ACI. In children with ACI, hypothalamo-pituitary-adrenal axis must be monitored and those having FRS and CRS must be evaluated in terms of glucocorticoid replacement therapy. It was reached a conclusion that if basal cortisol level is <25 ?g/dl, low dose ACTH test must be done and cortisol measurement in 0th and 30th minutes was enough. Other endocrine axes are also highly affected in children with ACI. Being the highest of hyperglycemia frequency in surgical cases shows the importance of glucose monitorization besides cortisol. IMA levels were firstly studied in children with ACI and the rate of IMA/albumin, decimal age and IL-10 level to AI risk effect were first determined.