title: Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: evidence of adrenal insufficiency?
abstract: OBJECTIVE
  To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Pediatric departments of four hospitals in Merseyside, United Kingdom.
  
  
  METHODS
  Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died.
  
  
  RESULTS
  Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs. Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level <5 microg/dL (<138 nmol/L) implying definite adrenal insufficiency. Three of 29 children with hypotension had plasma cortisol levels implying possible adrenal insufficiency (<18 microg/dL [<497 nmol/L]), but high ACTH levels were only found in one of those three. Cortisol levels decreased significantly after antibiotic treatment, unless steroid therapy was administered. ACTH levels did not correlate with cortisol or proinflammatory cytokine levels.
  
  
  CONCLUSIONS
  Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.
authors.affiliation: Institute of Child Health, University of Liverpool, United Kingdom.
authors.forename: F A
authors.initials: FA
authors.lastname: Riordan
authors.forename: A P
authors.initials: AP
authors.lastname: Thomson
authors.forename: J M
authors.initials: JM
authors.lastname: Ratcliffe
authors.forename: J A
authors.initials: JA
authors.lastname: Sills
authors.forename: M J
authors.initials: MJ
authors.lastname: Diver
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000172:deficiency; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000172:deficiency; D007223:Infant; D008589:Meningococcal Infections / Q000097:blood* / Q000150:complications; D010343:Patient Admission; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone