title: Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus.
abstract: There is little data documenting cortisol levels in children with diabetic ketoacidosis (DKA), despite the fact that untreated adrenal insufficiency (AI) could worsen the outcome of DKA. In this cross-sectional study, we assessed serum cortisol levels in 28 children with DKA and new onset type 1 diabetes mellitus evaluated at our center over a 5-year period. Average duration of diabetes-related symptoms was positively associated with age ( P = .002), and significantly lower hemoglobin A1c levels were observed in the youngest children. The mean cortisol level was 40.9 µg/dL, with a range of 7.8 to 119 µg/dL. Cortisol levels were found to be inversely associated with serum pH ( P = .007). There was no difference in the clinical outcome of the 4 patients who had cortisol levels less than 18 µg/dL. Overall, we did not find clinical or laboratory evidence of diminished cortisol reserve; however, the possibility of AI must be kept in mind when treating children with DKA.
authors.affiliation: 1 Columbia University Medical Center, New York, NY, USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Williams
authors.affiliation: 2 Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Fazzio
authors.affiliation: 1 Columbia University Medical Center, New York, NY, USA.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Oberfield
authors.affiliation: 3 New York University School of Medicine, New York, New York.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Gallagher
authors.affiliation: 1 Columbia University Medical Center, New York, NY, USA.
authors.forename: Gaya S
authors.initials: GS
authors.lastname: Aranoff
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000097:blood / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000150:complications*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D006854:Hydrocortisone
keywords: adrenal insufficiency; autoimmune; cortisol; diabetic ketoacidosis; type 1 diabetes mellitus