Adrenocorticotropic hormone and cortisol levels in relation to inflammatory response and disease severity in children with meningococcal disease

This prospective observational study investigated the relationship of the h ypothalamic-pituitary-adrenal axis to inflammatory markers and to disease s everity in children with meningococcal disease. In total, 32 children were studied: 10 with distinct meningococcal meningitis (MM), 10 with MM and sep tic shock, and 12 with fulminant meningococcal septicemia (FMS). Levels of adrenocorticotropic hormone (ACTH) and interleukin (IL)-6, IL-8, and IL-10 were lowest in the MM group and dramatically elevated in the FMS group. Cor tisol and C-reactive protein levels were highest in the MM group and relati vely low in the FMS group. Levels of ACTH and inflammatory markers decrease d within the first 24 h of admission, but cortisol levels did not fluctuate . Cortisol was significantly inversely correlated with IL-6, IL-8, and IL-n 10 (P less than or equal to .04). These results suggest that the adrenal r eserve in children is insufficient to handle the extreme conditions and str ess associated with severe meningococcal disease.