Frequência de insuficiência adrenal em crianças com sepse

Júnior, Arnildo Linck; Filho, Eduardo de Almeida Rego; Moriya, Luiza Kazuco; Cardoso, Jefferson Rosa

doi:10.1590/s0103-507x2011000400013

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…This also agrees with Arnildo et al . (2011), who described a state of adrenal exhaustion in chronic critical illness due to catecholamine receptor desensitization or down regulation and/or chronic secretion of cytokines and other substances that suppress the HPA axis.…”

Section: Discussionsupporting

confidence: 94%

“…Next, the entire axis is exhausted and peripheral cortisol resistance leads to the development of adrenal insufficiency. This also agrees with [14], who described a state of adrenal exhaustion in chronic critical illness due to catecholamine receptor desensitization or down regulation and/or chronic secretion of cytokines and other substances that suppress the HPA axis.…”

Section: Discussion Culture Proved Sepsissupporting

confidence: 92%

“…In addition to reduction of glucocorticoid receptors and an increase in the conversion of cortisol to inactive cortisone by enhanced activity of 11-B hydroxysteroid dehydrogenase stimulated by IL-2, IL-4, and IL-13. Mark (2003) and Arnildo et al . (2011) believed that a random cortisol level in severely stressed patients (ie.…”

Section: Discussionmentioning

confidence: 99%

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New insight of adrenal responses in premature neonates versus full term neonates in critical care setting

razek

Hashem

Osman

2020

Preprint

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Background: Adequate adrenocortical function is essential for survival of critically ill neonates. Although most of them display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic pituitary adrenal axis (HPA), yet; adrenocortical insufficiency is seen in septic shock. Objectives: Evaluate the HPA response in critically ill neonates with shock. Subjects:this prospective observational study included a total of 60 neonates divided into 3 groups;(A)30 critical ill neonates with septic shock on inotropic support, (B)15 patients with sepsis who did not need inotropic support and(C) control group(n=15). Methods: Adrenal functions were evaluated by taking a single diurnal ACTH reading and two readings for serum cortisol level (diurnal and nocturnal). Results: Gram negative organism was more prevalent among the patients; 53%, 63% in groups A and B respectively. Group A showed Significant statistical hypotension before vasopressor drug administration (p<0.001) as compared to both groups. Group A showed Significant statistical improvement of blood pressure after vasopressor drug administration (p<0.001) as compared to both groups B, C. Serum cortisol was significantly higher in group A(57.21 plus-or-minus sign 24.31) and B (48.01 plus-or-minus sign 18.27 ), while it was lower in group C(19.57plus-or-minus sign 16.05 ) . A highly statistically significant rise of serum cortisol level( p=0.000) and ACTH(p=0.000) in group A when was compared to the other two groupsConclusion: This study introduced a new pattern of serum cortisol response in neonates ranging from very high cortisol level to a near normal values; highlighting a state of glucocorticoid resistance in neonates and relative adrenal insufficiency.

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Section: Discussionsupporting

confidence: 94%

Section: Discussion Culture Proved Sepsissupporting

confidence: 92%

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New insight of adrenal responses in premature neonates versus full term neonates in critical care setting

razek

Hashem

Osman

2020

Preprint

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Salivary biomarkers may measure stress responses in critically ill children

et al. 2018

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Objective:Measurement of salivary biomarkers can provide important information regarding hypothalamic–pituitary–adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit.Methods:We enrolled 79 pediatric intensive care unit patients (2–14 years) over a 2-year period, which satisfy the including criteria, but finally salivary biomarkers were evaluated in 65 patients. Saliva samples were collected within 24 h of admission at 8 a.m., 2 p.m. and 8 p.m. to examine potential disruption of circadian rhythm.Results:Overall, the salivary biomarkers were increased; specifically, median values were (a) cortisol at 8 a.m.: 50.04 nmol/L, 2 p.m.: 30.69 nmol/L and 8 p.m.: 247.12 nmol/L; (b) α-amylase: at 8 a.m.: 22.567 U/L; 2 p.m.: 22.702 U/L and 8 p.m.: 21.484 U/L and (c) IgA at 8 a.m.: 95.10 mg/dL, 2 p.m.: 88.55 mg/dL and 8 p.m.: 80.80 mg/dL. Significantly higher levels were demonstrated in children younger than 6 years and those with Pediatric Risk Index Score of Mortality ⩾8 upon admission. Disturbances in circadian rhythm were observed. Cortisol circadian rhythm disturbance was observed only in children with Pediatric Risk Index Score of Mortality score ⩾8 upon admission while maintaining normal α-amylase circadian rhythm, which was associated with less than 3 days hospitalization in pediatric intensive care unit. No daily variance in IgA was observed.Conclusion:Salivary biomarkers may serve, in critically ill children, as a sensitive, non-invasive method, important for the early recognition of those at high risk and guiding intervention, before clinical deterioration, promoting the quality of health care in pediatric population.

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IL-1, IL-6, TNF-α, and MIF in relative adrenal insufficiency in septic shock: a piglet model

Akura¹,

Batubara²,

Munasir³

et al. 2020

Med J Indones

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BACKGROUND Inflammatory mediators released during septic shock are involved in the mechanism of adrenal insufficiency. This study investigated the role of interleukin (IL)-6, IL-1, tumor necrosis factor (TNF)-α, and macrophage migration inhibitory factor (MIF) in septic shock with relative adrenal insufficiency (RAI). METHODS We conducted a 6-month experimental study in 20 piglets. Following endotoxin administration, their hemodynamics were monitored and blood samples were drawn to test the levels of cytokines IL-1, IL-6, TNF-α, and MIF every 15 min until septic shock onset as well as during a corticotropin stimulation test. Septic shock was managed by administering fluid resuscitation, inotropic drugs, and hydrocortisone. At the end of the study, the piglet models were classified as either RAI or non-RAI. Immunohistochemistry staining was performed on the hypothalamus of the RAI group. RESULTS The level of IL-6 at 45 min was higher in the RAI group than the non-RAI group (p = 0.008), and that of IL-1 was similar in the two groups during septic shock. The RAI group had higher TNF-α levels at 15 min (p = 0.002) and at 30 min (p = 0.007) than the non-RAI group, and the MIF level during septic shock was higher in the RAI group (p = 0.003) than the non-RAI group. CONCLUSIONS Cytokine-induced inflammatory process of adrenal gland reflected in TNF-α level in 15 min and 30 min, IL-6 in 45 min, and MIF in septic shock condition but not in IL-1.

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Frequência de insuficiência adrenal em crianças com sepse

Cited by 3 publications

References 26 publications

New insight of adrenal responses in premature neonates versus full term neonates in critical care setting

New insight of adrenal responses in premature neonates versus full term neonates in critical care setting

Salivary biomarkers may measure stress responses in critically ill children

IL-1, IL-6, TNF-α, and MIF in relative adrenal insufficiency in septic shock: a piglet model

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