title: Adrenocortical function in the postoperative pediatric cardiac surgical patient.
abstract: OBJECTIVE
  Corticosteroids are frequently used in the postoperative care of children with congenital heart disease. This review describes the function of the adrenocortical axis in this population and the effects of corticosteroids on cardiovascular function. In addition, it examines the diagnosis of adrenal insufficiency in this population and provides an overview of recent studies on the use of steroids in treating hemodynamic instability in these children.
  
  
  RESULTS
  Corticosteroids improve hemodynamic parameters in children with shock following congenital heart surgery. This improvement may be due to treatment of adrenal insufficiency or from direct cardiovascular effects of corticosteroids. The diagnosis of adrenal insufficiency in this population is challenging as low cortisol levels do not consistently correlate with adverse outcomes.
  
  
  CONCLUSIONS
  Because of the lack of evidence delineating what the normal adrenocortical function is in this population, cortisol levels alone are not sufficient to justify treating with steroids in this population. Corticosteroids are beneficial in improving hemodynamics in children with shock after congenital heart surgery, but the adverse effects of the therapy in this context are not fully known. Prospective trials are necessary to clarify which patients may benefit from steroid therapy and to examine long-term effects of steroids.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. michael.green@utsouthwestern.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Green
authors.forename: Josh
authors.initials: J
authors.lastname: Koch
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002648:Child; D005938:Glucocorticoids / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids