[Evaluation of adrenocortical function in children with severe and critical enterovirus 71 infection].
OBJECTIVE
To evaluate the adrenocortical function in children with severe and critical enterovirus 71 infection by using a high-dose (250 µg) adrenocorticotropic hormone (ACTH) stimulation test. And to at provide experimental basis for glucocorticoid in the treatment of hand-foot-and-mouth disease (HFMD).


METHODS
This was a prospective multi-center study which was carried out in PICUs of Beijing Children's Hospital, Zhengzhou Children's Hospital, Kaifeng Children's Hospital and Linyi People's Hospital in Shandong province. Children with severe and critical hand-foot-mouth disease admitted to PICUs of the four hospitals from June 2009 to April 2010 were enrolled in this study, and EV71 virus nucleic acid test and high-dose (250 µg) ACTH stimulation started at the same time. EV71 virus nucleic acid positive 51 cases were eventually enrolled in the study. Cortisol test was performed at baseline (T0) and after high-dose (250 µg) ACTH stimulation at 30 minutes (T30), 60 minutes (T60) in the first 6 hours after admission, but before glucocorticoid was given. The adrenocortical function was evaluated according to ΔTmax [ΔTmax=(T30, T60 maximum)-T0]. Diagnostic criteria of adrenal insufficiency (AI) is increment (ΔTmax)≤9 µg/dl.


RESULTS
The incidence of AI in 51 cases was 52.94% (27/51). The incidence of AI in severe group was 44.74% (17/38), which was significantly higher in critical group 76.92% (10/13), P<0.05. Of the cases with a pediatric critical illness score (PCIS)≤70, 81.82% (9/11) had adrenal insufficiency, and it was 28.57% (4/14) when PCIS≥90. The incidence of AI was 75% (6/8) and 48.84% (21/43) in death and survivor group respectively, but there were no significant difference between the two groups (P>0.05). Baseline (T0) cortisol in death group was higher than survivor group (P<0.05).


CONCLUSIONS
AI may occur in children with enterovirus 71 infection. The critical enterovirus 71 infection had a high incidence of AI. AI may affect the prognosis of patients with severe and critical enterovirus 71 infection. Exogenous glucocorticoids administration may be considered when AI is identified or highly suspected. The timing, dosage and regimen of glucocorticoid are still unclear. Further animal experiments and clinical trials are needed.
Department of Emergency Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Jie
J
Wu
Yi-bing
YB
Cheng
Zhi-fang
ZF
Li
Yu-fen
YF
Li
Yu-ping
YP
Li
Hui-min
HM
Xu
Xing-wang
XW
Li
Su-yun
SY
Qian
D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000209:etiology*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D002675:Child, Preschool; D029821:Enterovirus A, Human / Q000472:pathogenicity*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
D000324:Adrenocorticotropic Hormone