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807 Hypocortisolemia in Sick Children on Paediatric Intensive Care Unit (PICU): Transient or Cause for Concern
  1. H Bentur1,
  2. S Mahoney1,
  3. J Blair2
  1. 1Paediatric Intensive Care
  2. 2Paediatric Endocrine, AlderHey Children’s NHS Foundation Trust, Liverpool, UK

Abstract

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.

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