Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Dexamethasone therapy and cortisol excretion in severe pediatric head injury

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Glucocorticoids are used in an attempt to reduce brain edema secondary to head injury. Nevertheless, their usefulness remains uncertain and contradictory. In a randomized study of 24 children with severe head injury, urinary free cortisol was measured by radioimmunoassay. Twelve patients (group 1) received dexamethasone and 12 (group 2) did not. All patients were treated with a standardized regimen. In group 1 there was complete suppression of endogenous cortisol production. In group 2 free cortisol was up to 20-fold higher than under basal conditions and reached maximum values on days 1–3. Since the excretion of cortisol in urine reflects the production rate closely and is not influenced by liver function and barbiturates, the results in group 2 show that the endogenous production of steroids is an adequate reaction to severe head injury. Exogenous glucocorticoids are thus unlikely to have any more beneficial effects than endogenous cortisol.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Andrassy RJ, Dubois T (1985) Modified injury severity scale and concurrent steroid therapy: independent correlates of negative nitrogen balance in pediatric trauma. J Pediatr Surg 20:799–802

  2. 2.

    Braakman R, Schouten JA, Blaauw-van Dishoeck M, Mindderhoud JM (1983) Megadose steroids in severe head injury. Results of a prospective double-blind clinical trial. J Neurosurg 58:326–330

  3. 3.

    Cooper P-R, Moody S, Clark WK, Kirkpatrick J, Maravilla K, Gould AL, Drane W (1979) Dexamethasone and severe head injury: a prospective double blind study. J Neurosurg 51:307–314

  4. 4.

    Dearden NM, Gibson JS, McDowall DG, Gibson RM, Cameron MM (1986) Effect of high dose dexamethasone on outcome from severe head injury. J Neurosurg 64:81–88

  5. 5.

    Galicich JH, French LA (1961) Use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Proctol 12:169–174

  6. 6.

    Saul TG, Ducker TB, Salcman M, Carro E (1981) Steroids in severe head injury: a prospective randomized clinical trial. J Neurosurg 54:596–600

  7. 7.

    Stolecke H (1970) The determination of free urinary cortisol — a modification of the method described by Gerdes and Staib and normal values in infants. Horm Metab Res 2:298–301

Download references

Author information

Correspondence to Jolanda Klöti.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klöti, J., Fanconi, S., Zachmann, M. et al. Dexamethasone therapy and cortisol excretion in severe pediatric head injury. Child's Nerv Syst 3, 103–105 (1987). https://doi.org/10.1007/BF00271134

Download citation

Key words

  • Head injury
  • Children
  • Dexamethasone
  • Endogenous cortisol