Adrenal insufficiency in septic shock

Background-Functional adrenal insufficiency has been documented in critical ly ill adults. Objective-To document the incidence of adrenal insufficiency in children wi th septic shock, and to evaluate its effect on catecholamine requirements, duration of intensive care, and mortality. Setting-Sixteen-bed paediatric intensive care unit in a university hospital . Methods-Thirty three children with septic shock were enrolled. Adrenal func tion was assessed by the maximum cortisol response after synthetic adrenoco rticotropin stimulation (short Synacthen test). Insufficiency was defined a s a post-Synacthen cortisol increment < 200 nmol/l. Results-Overall mortality was 33%. The incidence of adrenal insufficiency w as 52% and children with adrenal insufficiency were significantly older and tended to have higher paediatric risk of mortality scores. They also requi red higher dose vasopressors for haemodynamic stability. In the survivor gr oup, those with adrenal insufficiency needed a longer period of inotropic s upport than those with normal function (median, 3 v 2 days), but there was no significant difference in duration of ventilation (median, 4 days for ea ch group) or length of stay (median, 5 v 4 days). Mortality was not signifi cantly greater in children with adrenal insufficiency than in those with ad equate adrenal function (6 of 17 v 5 of 16, respectively). Conclusion-Adrenal insufficiency is common in children with septic shock. I t is associated with an increased vasopressor requirement and duration of s hock.