Identification of adrenal insufficiency in pediatric critical illness.
OBJECTIVE
To determine physicians' beliefs and practices regarding adrenal dysfunction in pediatric critical illness.


METHODS
Cross-sectional mail survey.


METHODS
Canada.


METHODS
All members of the Canadian Pediatric Endocrine Group and all physicians identified as practicing pediatric intensive care medicine in any of 16 tertiary care teaching centers in Canada.


METHODS
Three pediatric intensive care physicians and three pediatric endocrinologists reviewed the questionnaire before administration to ensure clarity. We asked participants to report their views on the following: a) the frequency of adrenal insufficiency in pediatric critical illness; b) diagnosis/definition of adrenal insufficiency in pediatric critical illness; and c) the use of empirical glucocorticoids in fluid/vasopressor-resistant hypotension in pediatric critical illness.


RESULTS
Forty-six of 57 (80.7%) endocrinologists responded, with 43 participating (75.4%). Among intensivists, 59 of 70 (84.3%) responded with no refusals. Of intensivists, 81.4% believe that adrenal insufficiency occurs sometimes or often in critically ill pediatric intensive care unit patients, whereas 41.8% of endocrinologists believe adrenal insufficiency occurs never or rarely in these patients. Six definitions of adrenal insufficiency were proposed (varying cortisol level vs. peak/increment of cortisol in response to corticotropin), with no consensus on the definition of adrenal insufficiency from the endocrinologists or intensivists. Half (50.9%) of intensivists said they would sometimes or often empirically treat hypotensive pediatric patients with glucocorticoids, whereas 81.0% of endocrinologists would occasionally or never recommend glucocorticoids on this basis.


CONCLUSIONS
There is no consensus among pediatric intensivists or endocrinologists as to how often adrenal insufficiency occurs in pediatric critical illness or how to diagnose this condition. Despite this lack of consensus, however, many pediatric intensivists would empirically treat hypotensive patients who they suspect may have adrenal insufficiency. Prospective studies are required to determine the definition, frequency, and appropriate treatment of adrenal insufficiency in critically ill pediatric patients.
Menon
Kusum
K
Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ontario, Canada. menon@cheo.on.ca
Lawson
Margaret
M
D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy; D002170:Canada; D002648:Child; D003422:Critical Care; D016638:Critical Illness; D003430:Cross-Sectional Studies; D004704:Endocrinology; D006801:Humans