Serum Cortisol Levels in Children with Catecholamine-Dependent Shock – A Prospective Observational Study

Abstract

Pediatric septic shock poses a significant challenge in ICUs worldwide, with high mortality and morbidity rates despite medical advancements. Early recognition and aggressive management are crucial. Resistance to standard therapies in some cases suggests potential adrenal insufficiency, particularly relative adrenal insufficiency (RAI), though research is limited. This study aimed to assess adrenal insufficiency prevalence in pediatric septic shock by evaluating basal serum cortisol levels in 49 children aged 1 month to 12 years admitted to the PICU. Results showed a significant 41% prevalence of adrenal insufficiency, correlating with prolonged critical care needs. Despite increased interventions, mortality rates didn't notably differ between groups. Recognition of adrenal insufficiency is vital due to its association with extended critical care requirements. Further research, including stimulation tests and trials, is needed to distinguish absolute and relative adrenal insufficiency and assess potential benefits of steroid supplementation. This study underscores the importance of comprehensive management strategies incorporating adrenal function assessment in improving outcomes for critically ill children with septic shock.