PICU Endocrine Issues

Adrenal Insufficiency

Cortisol Physiology

Figure 1: The HPA Axis

Assessment of Adrenal Insufficiency

Causes of Adrenal Insufficiency

Treatment

Figure 2: Relative Steroid Potencies

Hyperglycemia

Treatment

Thyroid Dysfunction

Sick Euthyroid Syndrome

References

1) D. Annane, V. Maxime, F. Ibrahim, et al.: Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med. 174 (12):1319-1326 2006 16973979

2) D. Annane, V. Sebille, C. Charpentier, et al.: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA.288 (7):862-871 2002 12186604

3) C.L. Sprung, D. Annane, D. Keh, et al.: Hydrocortisone therapy for patients with septic shock. N Engl J Med. 358 (2):111-124 2008 18184957

4) P.E. Marik, S.M. Pastores, D. Annane, et al.: Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 36 (6):1937-1949 2008 18496365

5) A.R. Yates, P.C.I.I. Dyke, R. Taeed, et al.: Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 7(4):351-355 2006 16738506

6).R.G. Branco, P.C. Garcia, J.P. Piva, et al.: Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med. 6 (4):470-472 2005 15982437

7) A. Cochran, E.R. Scaife, K.W. Hansen, et al.: Hyperglycemia and outcomes from pediatric traumatic brain injury. J Trauma. 55 (6):1035-1038 2003 14676647

8)D.C. Gore, D. Chinkes, J. Heggers, et al.: Association of hyperglycemia with increased mortality after severe burn injury. J Trauma. 51 (3):540-544 2001 11535907

9) N.J. Hall, M. Peters, S. Eaton, et al.: Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg. 39 (6):898-901 2004 15185221

10) G. van den Berghe, P. Wouters, F. Weekers, et al.: Intensive insulin therapy in the critically ill patients. N Engl J Med. 345 (19):1359-1367 2001 11794168

11) S. Finfer, et al.: for the NICE-SUGAR Study Investigators: Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 360 (13):1283-12972009 19318384

12) Agus MS, Steil GM, Wypij D, Costello JM, Laussen PC, Langer M, Alexander JL,Scoppettuolo LA, Pigula FA, Charpie JR, Ohye RG, Gaies MG; SPECS Study Investigators. Tight glycemic control versus standard care after pediatric cardiac surgery. N Engl J Med. 2012 Sep 27;367(13):1208-19. Epub 2012 Sep 7. PubMed PMID: 22957521; PubMed Central PMCID: PMC3501680. 

13) Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, Parslow R,Tasker RC, Elbourne D; CHiP Investigators. A randomized trial of hyperglycemic control in pediatric intensive care. N Engl J Med. 2014 Jan 9;370(2):107-18.