Serum Cortisol Level in Combination with High Adrenocortico-trophic Hormone Concentrations are Associated with Poor Outcome in Critically Ill Children

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Mostafa Sami Hassan ◽  
samir zanzam ◽  
nehad karam ◽  
Hanaa Elsayed
Keyword(s):  
Critically Ill ◽  
Cortisol Level ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Critically Ill Children ◽  
Poor Outcome ◽  
Trophic Hormone

scholarly journals Critical Illness – Related Corticosteroid Insufficiency

2015 ◽  
Vol 4 (1) ◽  
pp. 59
Author(s):  
Hamdollah Karamifar ◽  
Hossein Moravej ◽  
Zohreh Karamizadeh ◽  
Gholamhossein Amirhakimi
Keyword(s):  
Critical Illness ◽  
Corticosteroid Therapy ◽  
Steroid Therapy ◽  
Cortisol Level ◽  
Pediatric Intensive Care ◽  
Serum Cortisol ◽  
Serum Cortisol Level ◽  
Critically Ill Children ◽  
Cortisol Levels ◽  
Corticosteroid Insufficiency

In some acute critical illnesses, the function of Hypothalamus-Pituitary-Adrenal axis can be impaired. This event is called "Critical Illness-Related Corticosteroid Insufficiency" (CIRCI). We conducted a study to determine which of the CIRCI patients need steroid therapy. This study was performed on patients who were admitted in Pediatric Intensive Care Unit (PICU) in Nemazee Hospital, affiliated to Shiraz University of Medical Sciences, Iran.In first 24 hour of PICU admission, Serum cortisol levels were measured immediately before, 30 and 60 minutes after IV administration of 250 μg of synthetic adrenocorticotropic hormone (Synacthen®).Their clinical conditions and paraclinical data were followed and recorded. Twenty four patients were enrolled in the study. Twelve patients (50%) had CIRCI. CIRCI was defined as Random Serum Cortisol (RSC)<10 μg/dl or elevation of serum cortisol level after Synacthen administration below 9 µg/dl.The results of serum cortisol level usually were ready one day after blood sampling. Based on general condition, blood pressure and serum electrolyte levels, all CIRCI patients were improved when serum cortisol levels were determined. Therefore, steroid therapy was not started for them. Finally, all of the CIRCI patients improved and after a few days, all of them were discharged from the hospital with good conditions. Findings of our study showed that corticosteroid therapy is not needed as a routine treatment for CIRCI patients. This is in agreement with some other studies. but in contrast to some articles who recommended corticosteroid therapy for patients with CIRCI. There is lack of consensus about optimal approach to CIRCI in children, therefor; well-designed RCTs and systematic reviews are needed to determine proper treatment recommendations for these critically ill children before administration.

scholarly journals Different adrenal response of critically ill neonates; An Egyptian model

2020 ◽  
Author(s):  
Wafaa Osman ◽  
suzan abd razek
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Drug Administration ◽  
Cortisol Level ◽  
Serum Cortisol ◽  
Inotropic Support ◽  
Serum Cortisol Level ◽  
Minus Sign ◽  
Group A ◽  
Critically Ill Neonates

Background: Adequate adrenocortical function is essential for survival of critically ill neonates. Although most of them display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic pituitary adrenal axis (HPA), yet; adrenocortical insufficiency is seen in septic shock. Objectives: Evaluate the HPA response in critically ill neonates with shock. Subjects:this prospective observational study included a total of 60 neonates divided into 3 groups;(A)30 critical ill neonates with septic shock on inotropic support, (B)15 patients with sepsis who did not need inotropic support and(C) control group(n=15). Methods: Adrenal functions were evaluated by taking a single diurnal ACTH reading and two readings for serum cortisol level (diurnal and nocturnal). Results: Gram negative organism was more prevalent among the patients; 53%, 63% in groups A and B respectively. Group A showed Significant statistical hypotension before vasopressor drug administration (p<0.001) as compared to both groups. Group A showed Significant statistical improvement of blood pressure after vasopressor drug administration (p<0.001) as compared to both groups B, C. Serum cortisol was significantly higher in group A(57.21 plus-or-minus sign 24.31) and B (48.01 plus-or-minus sign 18.27 ), while it was lower in group C(19.57plus-or-minus sign 16.05 ) . A highly statistically significant rise of serum cortisol level( p=0.000) and ACTH(p=0.000) in group A when was compared to the other two groupsConclusion: This study introduced a new pattern of serum cortisol response in neonates ranging from very high cortisol level to a near normal values; highlighting a state of glucocorticoid resistance in neonates and relative adrenal insufficiency.

Nighttime serum cortisol level for diagnosis of hypercortisolism in hospitalized patients

2019 ◽  
Author(s):  
Liana Khatsimova ◽  
Uliana Tsoy ◽  
Natalia Kuritsyna ◽  
Elena Grineva ◽  
Elena Litvinenko ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Serum Cortisol ◽  
Hospitalized Patients ◽  
Serum Cortisol Level

Serum Cortisol Abnormalities after Craniocerebral Trauma

Neurosurgery ◽  
1979 ◽  
Vol 5 (5) ◽  
pp. 559-565 ◽  
Author(s):  
Paul Steinbok ◽  
Gordon Thompson
Keyword(s):  
Head Injury ◽  
Cortisol Level ◽  
Diurnal Rhythm ◽  
Elevated Serum ◽  
Craniocerebral Trauma ◽  
Serum Cortisol ◽  
Feedback Mechanism ◽  
Serum Cortisol Level ◽  
Skull Fractures ◽  
Middle Fossa

Abstract Serial estimations of serum cortisol were performed in 49 patients with craniocerebral trauma. Abnormalities of serum cortisol, including alterations in diurnal rhythm and elevations of serum cortisol level, occurred in 21 patients. The frequency and severity of the abnormalities correlated with the severity of the head injury, and there was a trend suggesting that middle fossa basal skull fractures predisposed to cortisol abnormalities. A further 6 patients were studied to assess the effects of exogenous dexamethasone, and in all patients there was suppression of elevated serum cortisol levels by the dexamethasone. The findings suggest that hypercortisolemia after head injury is related to an alteration rather than an abolition of the normal feedback mechanism.

scholarly journals Effects of Surgical Stress on Serum Cortisol Level: A Comparative Study between Elective and Emergency Surgery

1970 ◽  
Vol 2 ◽  
pp. 28-33
Author(s):  
SM Selimuzzaman ◽  
Noorzahan Begum ◽  
Nadira Islam ◽  
Shelina Begum
Keyword(s):  
Surgical Treatment ◽  
Cortisol Level ◽  
Surgical Stress ◽  
Serum Cortisol ◽  
Study Groups ◽  
Serum Cortisol Level ◽  
Control Group ◽  
Surgical Interventions ◽  
Group I ◽  
Healthy Control

The study was designed to observe the effects of surgical stress on serum level of cortisol in patients undergoing surgical treatment and to find out any differences in hormonal response between elective and emergency surgical procedures. A total number of 60 male subjects aged between 18 and 45 years were included in the study. Of them, 20 were healthy control (Group I), 20 underwent elective surgical treatment (Group II) and emergency surgical interventions were applied in rest 20 subjects (Group III). Study Groups were further divided into subgroups A (preoperative samples were collected 1- hour before operation), B (postoperative samples were collected 1-hour after the end of the operation) and C (postoperative samples were collected 24-hours after operation).Serum cortisol level was estimated by invitro-immunolytic test.Statistical analysis was done by paired, unpaired ‘t' test and regression analysis. The preoperative mean serum cortisol concentration in elective surgical cases was almost similar to that of healthy control. On the contrary, in the emergency surgical cases, a significantly increased mean cortisol level were observed (I vs IIIA and IIA vs IIIA; P < 0.05). The serum cortisol concentrations were increased both in elective and emergency surgical cases after operations but the magnitude of rise was more marked in emergency group of patients (IIB vs IIIB; P < 0.05). Therefore, this study reveals that surgical intervention causes increase in serum cortisol which is more marked in emergency procedure. Key Words: Stress; Cortisol; Surgery DOI:10.3329/jbsp.v2i0.981 J Bangladesh Soc Physiol. 2007 Dec;(2): 28-33.

Increased Total Serum Random Cortisol Levels Predict Mortality in Critically Ill Trauma Patients

2014 ◽  
Vol 80 (11) ◽  
pp. 1112-1118 ◽  
Author(s):  
Urmil Pandya ◽  
Nathan Polite ◽  
Teresa Wood ◽  
Michael Lieber
Keyword(s):  
Injury Severity Score ◽  
Critically Ill ◽  
Cortisol Level ◽  
Severity Score ◽  
Odds Ratio ◽  
Injury Severity ◽  
Serum Cortisol ◽  
Total Serum ◽  
Trauma Patients ◽  
Cortisol Levels

Dysfunction in the hypothalamopituitary adrenal axis is thought to exist; however, there continues to be controversy about what level of serum cortisol corresponds to adrenal insufficiency. Few studies have focused on the significance of serum random cortisol in the critically ill trauma patient. Trauma patients with total serum random cortisol levels drawn in the intensive care unit within the first seven days of hospitalization were retrospectively reviewed. The primary outcome measured was in-hospital mortality. Two hundred forty-two patients were analyzed. Non-survivors had significantly higher mean cortisol levels than survivors (28.7 ± 15.80 mg/dL vs 22.9 ± 12.35 mg/dL, P = 0.01). Patients with cortisol 30 mg/dL or greater were more likely to die with odds ratio of 2.7 (95% confidence interval [CI], 1.5 to 5). The odds ratio increased to 4.0 and 3.8 (95% CI, 1.4 to 11.4 and 1.3 to 10.9) when cortisol was drawn on hospital Day 2 and Days 3 through 7, respectively. Among nonsurvivors, patients with an injury severity score less than 25 had significantly higher cortisol levels than patients with an Injury Severity Score 25 or higher (35.3 ± 19.21 mg/dL vs 25.7 ± 13.21 mg/dL, P = 0.009). Patients with massive transfusion, traumatic brain injury, spinal cord injury, or solid organ injury did not have significantly different cortisol levels. The covariate-adjusted area under the receiver operating characteristic curve indicated that cortisol level has a 77 per cent accuracy in differentiating survivors from nonsurvivors. Higher cortisol levels were predictive of mortality in critically ill trauma patients. Whether serum cortisol level is a marker that can be modified remains an area of interest for future study.

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