Basics pp 151-159 | Cite as

Adrenal Insufficiency in Pediatric Critical Illness

  • Giuliana Rizzo
  • Kusum Menon
Part of the Anaesthesia, Intensive Care and Pain in Neonates and Children book series (AICPNC)


The hormonal response to nonendocrine illness has a crucial importance in pediatric critical illness. Prompt recognition of hormonal deficiency or excess as a cause of critical illness leads to specify therapy for what often appears to be a nonspecific clinical syndrome. In recent years, we have become more aware of the physiological, possibly adaptive, alterations in endocrine function that occur in response to critical illness. The pediatric intensivist needs to interpret the hormonal studies properly and to treat the childhood endocrine disorders and the life-threatening complications that can occur in the course of a pediatric critical illness.


Critical Illness Pediatric Intensive Care Unit Adrenal Insufficiency Congenital Adrenal Hyperplasia ACTH Stimulation 
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  1. 1.
    Williams HW, Dluhy RG (1998) Diseases of the adrenal cortex. In: Fauci AS, Braunwald E, Isselbacher KJ et al (eds) Harrison’s principles of internal medicine. McGraw-Hill, New York, pp 2035–2057Google Scholar
  2. 2.
    Langer M, Modi BP, Agus M (2006) Adrenal insufficiency in the critically ill neonate and child. Curr Opin Pediatr 18:448–453CrossRefPubMedGoogle Scholar
  3. 3.
    Watterberg KL (2004) Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol 9:13–21CrossRefPubMedGoogle Scholar
  4. 4.
    Waterhouse R (1911) A case of suprarenal apoplexy. Lancet 1:577–578CrossRefGoogle Scholar
  5. 5.
    Wagner RL, White PF, Kan PB et al (1984) Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 310:1415–1421PubMedGoogle Scholar
  6. 6.
    Papanicolaou DA, Tsigos C, Oldfield EH, Chrousos GP (1996) Acute glucocorticoid deficiency is associated with plasma elevations of interleukin-6: does the latter participate in the symptomatology of the steroid withdrawal syndrome and adrenal insufficiency? J Clin Endocrinol Metab 81:2303–2306CrossRefPubMedGoogle Scholar
  7. 7.
    Cooper MS, Stewart PM (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:727–734CrossRefPubMedGoogle Scholar
  8. 8.
    Menon K, Clarson C (2002) Adrenal function in pediatric critical illness. Pediatr Crit Care Med 3:112–116CrossRefPubMedGoogle Scholar
  9. 9.
    Menon K, Lawson M (2007) Identification of adrenal insufficiency in pediatric critical illness. Pediatr Crit Care Med 8:276–278CrossRefPubMedGoogle Scholar
  10. 10.
    Hildebrandt T, Mansour M, Al Samsam R (2005) The use of steroids in children with septicemia: review of the literature and assessment of current practice in PICUs in the UK. Paediatr Anaesth 15:358–365CrossRefPubMedGoogle Scholar
  11. 11.
    Hatherill M, Tibby SM, Hilliard T et al (1999) Adrenal insufficiency in septic shock. Arch Dis Child 80:51–55CrossRefPubMedGoogle Scholar
  12. 12.
    Pizarro CF, Troster EJ, Damiani D, Carcillo JA (2005) Absolute and relative adrenal insufficiency in children with septic shock. Crit Care Med 33:855–859CrossRefPubMedGoogle Scholar
  13. 13.
    Shulman DI, Palmert MR, Kemp SF; Lawson Wilkins Drug and Therapeutics Committee (2007) Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 119:e484–e494CrossRefPubMedGoogle Scholar
  14. 14.
    White PC, Speiser PW (2000) Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 21:245–291CrossRefPubMedGoogle Scholar
  15. 15.
    Trimarchi T (2006) Endocrine problems in critically ill children: an overview. AACN Clinical Issues 17:66–78PubMedCrossRefGoogle Scholar
  16. 16.
    Van den Berghe G (2003) Endocrine evaluation of patients with critical illness. Endocrinol Metab Clin N Am 32:385–410CrossRefGoogle Scholar
  17. 17.
    Johnson KL, Rn CR (2006) The hypothalamic-pituitary-adrenal-axis in critical illness. AACN Clin Issues 17:39–49PubMedGoogle Scholar
  18. 18.
    Cronin L, Cook DJ, Carlet J et al (1995) Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 23:1430–1439CrossRefPubMedGoogle Scholar
  19. 19.
    Fernandez E, Schrader R, Watterberg K (2005) Prevalence of low cortisol values in term and near-term infants with vasopressor-resistant hypotension. J Perinatol 25:114–118CrossRefPubMedGoogle Scholar
  20. 20.
    Watterberg KL, Gerdes JS, Cole CH et al (2004) Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 114:1649–1657CrossRefPubMedGoogle Scholar
  21. 21.
    Stoll BJ, Temprosa M, Tyson JE et al (1999) Dexamethasone therapy increases infection in very low birth weight infants. Pediatrics 104:e63CrossRefPubMedGoogle Scholar
  22. 22.
    Markovitz BP, Goodman DM, Watson RS et al (2005) A retrospective cohort study of prognostic factors associated with outcome in pediatric severe sepsis: what is the role of steroids? Pediatr Crit Care Med 6:270–274CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Giuliana Rizzo
    • 1
  • Kusum Menon
    • 2
  1. 1.Department of Anesthesia and Intensive Care, Pediatric Anesthesia and Intensive Care SectionCatania University HospitalCataniaItaly
  2. 2.Children’s Hospital of Eastern OntarioUniversity of OttawaOttawaCanada

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