Endogenous cortisol levels increase during acute illness in children and adolescents: JAMA
UK: Circulating cortisol levels were found to be higher during acute illnesses in children and adolescents without glucocorticoid (GC) deficiency compared to controls in a systematic review and also varied across a range of acute illnesses. The study was featured in JAMA Network Open on June 22, 2022.
In children and adolescents, endogenous cortisol levels during acute illnesses can contribute to the evidence bases needed to optimize GC stress doses for children and adolescents known to have GC deficiency.
Mohammad Rezai, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom, and colleagues conducted the study with the objective to identify endogenous cortisol levels during a range of acute illnesses in children and adolescents without GC deficiency from published evidence.
For this purpose, the researchers searched the online databases for studies published between January 1, 2000, and June 30, 2020. Relevant studies were independently identified by two reviewers. Differences were resolved by joint discussion.
Inclusion criteria included age 1 month to 18 years, common acute illnesses, and basal blood cortisol levels obtained within 48 hours of presentation. Studies having less than 5 participants and those that included participants known to have GC deficiency or a history of treatment that could affect cortisol levels were excluded.
The study led to the following findings:
- All 15 studies included were hospital-based and included 864 unique participants: 14 studies were prospective observational studies, 1 was part of a trial, and 5 included control individuals.
- Mean cortisol levels were higher in all participants with an acute illness (n = 689) than in controls (n = 175) (difference in weighted means, 18.95 μg/dL).
- Cortisol levels were highest in patients with bacterial meningitis (weighted mean, 46.42 μg/dL) and were more than 3-fold higher in the group with severe gastroenteritis (weighted mean, 39.64 μg/dL) than in the control group.
- Among the subgroups with sepsis, those with shock had lower cortisol levels than those without shock (weighted mean, 27.83 μg/dL vs 37.00 μg/dL), but levels in nonsurvivors did not differ from levels in survivors (weighted mean, 24.89 μg/dL vs 30.53 μg/dL).
These findings indicate that for getting cortisol levels observed in children and adolescents with an intact hypothalamic-pituitary-adrenal axis during a range of acute illnesses, there is a need to tailor stress doses of glucocorticoids for children and adolescents with glucocorticoid deficiency in accordance with the nature and severity of the acute illness.
Reference:
Rezai M, Fullwood C, Hird B, et al. Cortisol Levels During Acute Illnesses in Children and Adolescents: A Systematic Review. JAMA Netw Open. 2022;5(6):e2217812.
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