Adrenal function in sepsis and septic shock.
OBJECTIVE
To review diagnostic criteria and treatment of adrenal insufficiency in pediatric patients with severe sepsis and septic shock.


METHODS
Articles were selected using MEDLINE (1966-June 2007), Embase (1994-2007) and Cochrane Library (2000-2007) databases. following key words were utilized: septic shock, sepsis, corticosteroids, adrenal insufficiency and children.


RESULTS
There are no well established and accepted criteria to define adrenal insufficiency in critically ill patients. Incidence of adrenal insufficiency varies according to different criteria, and it may range between low values of 15% and high values of 61%. The rapid corticotropin stimulation test is widely used as a method to identify adrenocortical hyporesponsiveness, but controversy exists as to the corticotropin dose to be used. The 250 microg dose is the standard dose. Low doses of corticotropin (1microg) have recently been proposed, suggesting that they may have higher sensitivity. There are still doubts as to the efficacy of low doses of corticosteroids in children with catecholamine-refractory shock. Further studies are needed to determine whether the treatment of these patients would change morbidity and/or mortality.


CONCLUSIONS
Adrenal insufficiency is common in children with severe sepsis and septic shock and may contribute to the development of catecholamine-refractory shock. However, doubts still persist regarding the efficacy of replacement therapy with low-doses steroids.
Pizarro
Cristiane Freitas
CF
Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. crispizarro@terra.com.br
Troster
Eduardo Juan
EJ
D000293:Adolescent; D000304:Adrenal Cortex Function Tests; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000324:Adrenocorticotropic Hormone; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone