title: [Adrenal function in children with sepsis and septic shock].
abstract: OBJECTIVE
  To assess adrenal function in children with sepsis and septic shock with petechiae and to investigate the possible relationship between adrenal hypofunction, sonographic diagnosis of massive bilateral adrenal hemorrhage, and other factors available early in this disturbance.
  
  
  METHODS
  Prospective observational study of 24 patients (14 boys, 10 girls), aged 2.9.24 years, admitted to the pediatric intensive care unit with sepsis and septic shock with petechiae during a 1.5-year period. The control group included 26 healthy children (13 boys, 13 girls), aged 8.8.6.4.2 years. Plasma cortisol and adrenocorticotropic hormone (ACTH) were measured by radioimmunoassay and adrenal ultrasonography was performed.
  
  
  RESULTS
  Plasma cortisol and ACTH levels were 243.7 ng/ml and 135.0 pg/ml in the patient group and 145.4 ng/ml and 21.1 pg/ml in the control group (p<0.01 in both). Adrenal insufficiency was found in four patients. Children with insufficiency more frequently required noradrenaline than did those with normal adrenal function (4/4 vs 2/20). Necrotic purpura (2/4 vs 2/20), massive adrenal hemorrhage (2/3 vs 1/20), lower platelet count (69.500 vs 212.895/l), lower prothrombin activity (19.0 vs 49.2%), lower fibrinogenemia (51.2 vs 304,4 mg/dl), higher pediatric risk of mortality III (PRISM III) scores (11.7 vs 2.7) and higher mortality rate (3/4 vs 1/20) were found in children with adrenal insufficiency than in those with normal adrenal function.
  
  
  CONCLUSIONS
  Plasma cortisol and ACTH levels were increased in children with sepsis and septic shock. Adrenal insufficiency was uncommon. Adrenal insufficiency was associated with severe hemodynamic failure, necrotic purpura, disseminated intravascular coagulopathy, massive bilateral adrenal hemorrhage and high mortality rate.
authors.affiliation: Unidades de Cuidados Intensivos Pediátricos.Complejo Hospitalario Carlos Haya. Málaga.
authors.forename: E
authors.initials: E
authors.lastname: García García
authors.forename: G
authors.initials: G
authors.lastname: Milano Manso
authors.forename: J P
authors.initials: JP
authors.lastname: López Siguero
authors.forename: E
authors.initials: E
authors.lastname: Valls Moreno
authors.forename: C
authors.initials: C
authors.lastname: Calvo Macías
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D011446:Prospective Studies; D011693:Purpura; D018805:Sepsis / Q000503:physiopathology*; D012772:Shock, Septic / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone