• Marieke den Brinker, Koen F M Joosten, Olivia Liem, Frank H de Jong, Wim C J Hop, Jan A Hazelzet, Marije van Dijk, and Anita C S Hokken-Koelega.
• Department of Pediatrics, Division of Endocrinology and Division of Pediatric Intensive Care, Erasmus Medical Center--Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. m.denbrinker@erasmusmc.nl
• J. Clin. Endocrinol. Metab. 2005 Sep 1;90(9):5110-7.

ContextAdequate adrenal function is pivotal to survive meningococcal sepsis.ObjectivesThe objective of the study was to evaluate adrenocortical function in meningococcal disease.DesignThis was an observational cohort study.SettingThe study was conducted at a university-affiliated pediatric intensive care unit.PatientsSixty children with meningococcal sepsis or septic shock participated in the study.Main Outcome MeasuresThe differences in adrenal function between nonsurvivors (n = 8), shock survivors (n = 43), and sepsis survivors (n = 9) on pediatric intensive care unit admission were measured.ResultsNonsurvivors had significantly lower median cortisol to ACTH ratio than shock survivors and sepsis survivors. Because cortisol binding globulin and albumin levels did not significantly differ among the groups, bioavailable cortisol levels were also significantly lower in nonsurvivors than sepsis survivors. Nonsurvivors had significantly lower cortisol to 11-deoxycortisol ratios but not lower 11-deoxycortisol to 17-hydroxyprogesterone ratios than survivors. Using multiple regression analysis, decreased cortisol to ACTH ratio was significantly related to higher IL-6 levels and intubation with etomidate (one single bolus), whereas decreased cortisol to 11-deoxycortisol ratio was significantly related only to intubation with etomidate. Aldosterone levels tended to be higher in nonsurvivors than shock survivors, whereas plasma renin activity did not significantly differ.ConclusionsOur study shows that the most severely ill children with septic shock had signs of adrenal insufficiency. Bioavailable cortisol levels were not more informative on adrenal function than total cortisol levels. Besides disease severity, one single bolus of etomidate during intubation was related to decreased adrenal function and 11beta-hydroxylase activity. Decreased adrenal function was not related to decreased 21-hydroxylase activity. Based on our results, it seems of vital importance to take considerable caution using etomidate and consider combining its administration with glucocorticoids during intubation of children with septic shock.

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