title: Adrenocorticotropic hormone and cortisol levels in relation to inflammatory response and disease severity in children with meningococcal disease.
abstract: This prospective observational study investigated the relationship of the hypothalamic-pituitary-adrenal axis to inflammatory markers and to disease severity in children with meningococcal disease. In total, 32 children were studied: 10 with distinct meningococcal meningitis (MM), 10 with MM and septic shock, and 12 with fulminant meningococcal septicemia (FMS). Levels of adrenocorticotropic hormone (ACTH) and interleukin (IL)-6, IL-8, and IL-10 were lowest in the MM group and dramatically elevated in the FMS group. Cortisol and C-reactive protein levels were highest in the MM group and relatively low in the FMS group. Levels of ACTH and inflammatory markers decreased within the first 24 h of admission, but cortisol levels did not fluctuate. Cortisol was significantly inversely correlated with IL-6, IL-8, and IL-10 (P < or =.04). These results suggest that the adrenal reserve in children is insufficient to handle the extreme conditions and stress associated with severe meningococcal disease.
authors.affiliation: Emma Children's Hospital, Academic Medical Center, Pediatric Intensive Care Unit, 1100 DE Amsterdam, The Netherlands. j.b.vanwoensel@amc.uva.nl
authors.forename: J B
authors.initials: JB
authors.lastname: van Woensel
authors.forename: M H
authors.initials: MH
authors.lastname: Biezeveld
authors.forename: A M
authors.initials: AM
authors.lastname: Alders
authors.forename: A J
authors.initials: AJ
authors.lastname: Eerenberg
authors.forename: E
authors.initials: E
authors.lastname: Endert
authors.forename: E C
authors.initials: EC
authors.lastname: Hack
authors.forename: I A
authors.initials: IA
authors.lastname: von Rosenstiel
authors.forename: T W
authors.initials: TW
authors.lastname: Kuijpers
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D016470:Bacteremia / Q000097:blood / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008585:Meningitis, Meningococcal / Q000097:blood* / Q000276:immunology; D008589:Meningococcal Infections / Q000097:blood* / Q000276:immunology*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D016207:Cytokines; D000324:Adrenocorticotropic Hormone; D002097:C-Reactive Protein; D006854:Hydrocortisone