Abstract
Purpose
A high incidence of secondary adrenal insufficiency (AI) has been reported several months after a traumatic brain injury (TBI)
in pediatric patients. Data from studies in adults suggest that AI may occur during the acute phase of TBI, with potential
negative effects in the management of these vulnerable patients. The aim of this study was to describe the prevalence and
the characteristics of AI in the acute phase of pediatric TBI.
in pediatric patients. Data from studies in adults suggest that AI may occur during the acute phase of TBI, with potential
negative effects in the management of these vulnerable patients. The aim of this study was to describe the prevalence and
the characteristics of AI in the acute phase of pediatric TBI.
Methods
Adrenal function was systematically evaluated in patients admitted to the pediatric intensive care unit following a TBI. Serial
measurements of cortisol (9 samples) and adrenocorticotropic hormone (ACTH) were drawn from the second morning to the third
morning post admission. Secondary AI was defined as all cortisols <200 nmol/l (6 ?g/dl) with ACTH <12 pmol/l.
measurements of cortisol (9 samples) and adrenocorticotropic hormone (ACTH) were drawn from the second morning to the third
morning post admission. Secondary AI was defined as all cortisols <200 nmol/l (6 ?g/dl) with ACTH <12 pmol/l.
Results
Twenty-eight patients (2–15 years old) were evaluated. Secondary AI occurred in ten (36%) patients. AI was more frequent in
patients with intracranial hypertension (p < 0.05). Patients with AI required longer mechanical ventilation (p < 0.05), and a non-significant trend for a higher Pediatric Logistic Organ Dysfunction score (p = 0.09) and greater norepinephrine dose (p = 0.11) was observed.
patients with intracranial hypertension (p < 0.05). Patients with AI required longer mechanical ventilation (p < 0.05), and a non-significant trend for a higher Pediatric Logistic Organ Dysfunction score (p = 0.09) and greater norepinephrine dose (p = 0.11) was observed.
Conclusions
Secondary AI is frequent during the acute phase of pediatric TBI, particularly when intracranial hypertension is present.
Systematic assessment of pituitary function after TBI appears to be essential. A randomized clinical trial is warranted to
evaluate the benefits of hormonal replacement therapy in TBI patients with AI.
Systematic assessment of pituitary function after TBI appears to be essential. A randomized clinical trial is warranted to
evaluate the benefits of hormonal replacement therapy in TBI patients with AI.
- Content Type Journal Article
- DOI 10.1007/s00134-010-2012-4
- Authors
- Clementine Dupuis, Department of Pediatrics, Pediatric Endocrinology, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Sebastien Thomas, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Patrice Faure, Department of Integrated Biology, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Armelle Gayot, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Amelie Desrumaux, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Isabelle Wroblewski, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Thierry Debillon, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Guillaume Emeriaud, Pediatric Intensive Care Unit, University Hospital of Grenoble, 38043 Grenoble Cedex 9, France
- Journal Intensive Care Medicine
- Online ISSN 1432-1238
- Print ISSN 0342-4642
No comments:
Post a Comment