Table 2

 Studies evaluating adrenal function in children with meningococcal disease

CitationStudy groupStudy typeOutcomeKey resultComments
Bone et al (2002)565 children with meningococcal disease Divided according to the intensive management required: I = mild, II = moderate, III = extensiveProspective cohort studyAdmission, 8 am and post-low dose Synachthen test (LDST) cortisol levels AI defined as (a) cortisol lower than 140 nmol/l; (b)LDST cortisol lower than 500 nmol/lAI = 16.9% (11/65) (a = 8, b = 6) 8am cortisol I<II (p<0.05) II>III (p = 0.07) LDST cortisol I = II II>III (p<0.05)Lost 21 (24%) patients on enrolment 13 (35%) did not have LDST Doesn’t specify previous use steroids
De Kleijn et al (2002)662 children with meningococcal sepsis Divided as: I = sepsis (12) II = shocked survivor (38) III = shocked non-survivor (12)Prospective cohort studyAdmission cortisol and adrenocorticotrophic hormone (ACTH) levels AI defined as cortisol <138 nmol/l, partial AI defined as cortisol from 138 to 497 nmol/lNone had AI 7 (11,3%) children had partial AI Cortisol (nmol/l): I(1158)>II (997)>III (654)Didn’t test response to corticotrophin 12 children were non-shocked Incidence of partial AI was 14%(7) among shocked
Riordan et al (1999)796 children with meningococcal disease Divided as meningococcal sepsis (MS = 43); meningococcal meningitis + septicaemia (MM+MS = 46); meningococcal meningitis (MM = 7)Prospective cohort studyAdmission cortisol and mortalityCortisol (nmol/l): MM 970 MM+MS 1268 MS 1183 Survivors > non-survivorsSepsis definition is not described. Do not specify previous steroid treatment Small group hypotensive (29), with 10.3%incidence of partial AI 10 referral had samples later, lower cortisol and higher mortality