Cortisol Secretion in Children With Varicella or Rubeola

Abstract

has been exposed to or develops varicella, should the glucocorticoid therapy be discontinued, or should the dose be modified? A dilemma exists. Finkel3 has recommended that the drug be discontinued; some suggest that the dose be decreased to physiologic amounts 4 and others urge that the dose be increased.5 We suspected that the problem might be clarified by studying the cortisol secretion of normal children with a viral exanthem. Knowing whether the cortisol secretion is low, normal, or high in these youngsters, one would be justified in prescribing a comparable dose of glucocorticoids for the sick child who had been receiving large amounts. We are reporting the results of such studies in otherwise healthy children with chickenpox or measles and making recommendations for the management of the patient taking large doses of glucocorticoids who is exposed to or develops varicella. Materials and MethodsClinical Material.-The children are from the private practice of one author (J.M.M.) and, except for the acute disease, are healthy. Infec¬ tion with rubeola or varicella was diagnosed from history and physical examination. Mothers collected urines at home from their children for four 24-hour periods: two periods during the first days of the exanthem, and two periods one to two months later, after the children had com¬ pletely recovered.In regard to the subjects with varicella, col¬ lections were begun on either day one or day two of the exanthem. The children did not re¬ ceive drugs other than salicylates and, in two instances, hydroxyzine hydrochloride (Atarax) for itching. Collections from patients with rube¬ ola were begun on either day one or day two of the exanthem, usually three to five days after the onset of fever and respiratory symp¬ toms. All children were febrile to some extent during the period of urine collections and all received salicylates. Several of the children were also given penicillin or a broad spectrum anti-

Adrenal Glucocorticoid Function in Acute Viral Infections in Children

“…Lorenz & Rossipal (16) found a significant rise of urinary 17-OHCS during the prodromal and early eruptive state of measles. Aceto and associates (1) reported almost normal levels of urinary 17-OHCS and cortisol production rates in man in non-complicated cases of measles and chicken pox. reported high rates of cortisol production in fatal cases of german measles and chicken pox encephalopathy, while the rates were normal in survivors with milder form of encephalopathy.…”

“…Few laboratory data are available concerning the adrenocortical function during acute viral infections. In measles, estimations of the urinary 17-OHCS were done in a small number of cases and the results were contradictory (1,16). Plasma glucocorticoids were not studied in uncomplicated cases of chicken pox.…”

“…The aim of the present work is: (1) To study the hypothalamic-pi tui tary-adrenal system during certain acute viral infections. (2) From these studies information may be obtained as regards the need for corticosteroid therapy in these viral infections.…”