Background and Aims Cortisol insufficiency has been reported in sick children with severe sepsis, post-cardiac surgery, and may contribute to rapid cardiovascular collapse. Hypothalamic-pituitary-adrenal axis dysfunction may play a role in low-cardiac-output syndrome. We performed a review of PICU patients to describe cortisol levels in those with suspected adrenal insufficiency.
Methods Retrospective review of PICU patients (general and cardiac cases) over 6 months from April to September 2011, who had cortisol levels checked and/or received hydrocortisone.
Results Total PICU admissions were 519, of which 30(5.7%) patients had cortisol levels. Most common indication for cortisol assessment was refractory hypotension (73%) in cardiac and sepsis patients. 12/30(40%) had cortisol levels < 500nmol/L (suboptimal response to stress), and 2/12 had undetectable cortisol levels. Of 12 with low cortisol, 50% were post-operative cardiac neonates and 50% were mix of other post-operative and chronic illness, 75% were hypotensive on inotropes and one-third of these received hydrocortisone in PICU. Hydrocortisone dose used was variable. None of the septic children had low cortisol in our study group. 50% of hypocortisolemia patients were followed up by endocrine team and had normal cortisol levels on follow-up. 10/30(33%) patients with suspected adrenal insufficiency died (50% had hypocortisolemia).
Conclusions Our data shows that hypocortisolemia can be transient in sick PICU patients, and may play a role in low-cardiac-output syndrome. There is a need to identify these complex patients with high mortality, and have a uniform management policy jointly with advice and follow-up by the Endocrine team.