Critical illness-related corticosteroid insufficiency in children.
Adequate adrenocortical function is essential for survival in critical illness. Most critically ill patients display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic-pituitary-adrenal axis and is considered to be a homeostatic adaptation. However, many critically ill patients have 'relative' or 'functional' adrenal insufficiency, which is characterized by an inadequate production of cortisol in relation to an increased demand during periods of severe stress. Recently, the term 'critical illness-related corticosteroid insufficiency' (CIRCI) was coined. CIRCI occurs as a result of a decrease in adrenal steroid production or tissue resistance to glucocorticoids. An international task force of the American College of Critical Care Medicine issued recommendations for the diagnosis and management of this condition in adult patients. We review the prevalence, diagnosis, and therapeutic approach to adrenal insufficiency in critically ill children. We found a lack of consensus within the pediatric field as to the optimal approach to CIRCI, and call for an international task force to establish unified guidelines.
Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
Yael
Y
Levy-Shraga
Orit
O
Pinhas-Hamiel
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000172:deficiency*; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000473:pathology; D007223:Infant; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000473:pathology
D000305:Adrenal Cortex Hormones