Document Detail

Hepatoadrenal syndrome in pediatric patients with end-stage liver disease.
MedLine Citation:
PMID:  21926658     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: Adrenal insufficiency in patients with liver failure, referred to as hepatoadrenal syndrome, is well characterized in adult patients but has not yet been described in children. We present 22 pediatric subjects with end-stage liver disease and adrenal insufficiency, diagnosed using the cosyntropin stimulation test. DESIGN AND SETTING:: A retrospective chart review using inpatient records from a pediatric intensive care unit in an academic medical center with a busy pediatric transplant program. PATIENTS:: Most were infants with anatomical short gut and severe, total parenteral nutrition-induced liver failure awaiting liver transplantation. Many were critically ill; 68% required mechanical ventilation and 59% required vasopressors. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: All patients had low baseline cortisol levels and ten also had an abnormal cosyntropin stimulation test. Cortisol levels at baseline and increments of serum cortisol at 30 and 60 mins post cosyntropin were 9.3 ± 5 μg/dL, 9.3 ± 4 μg/dL, and 10.7 ± 6 μg/dL, respectively, compared to these values in five patients with liver failure and normal adrenal function (21.3 ± 3 μg/dL, 10.5 ± 5 μg/dL, and 12.7 ± 3 μg/dL, respectively). Baseline cortisol levels were higher in patients who required vasopressors (11.1 ± 5 μg/dL) compared to those who did not (6.6 ± 4.3 μg/dL, p = .04), and 60-min increment cortisol levels were lower in nonsurvivors compared to survivors (8.6 ± 4.8 μg/dL vs. 15.1 ± 5.1 μg/dL, p = .002). The severity of adrenal insufficiency did not correlate with the degree of hepatic decompensation. Clinical characteristics, including serum electrolytes and vasopressor requirements, were similar in patients with hepatoadrenal syndrome and patients with liver failure and normal adrenal function. Twelve (55%) of the patients died in the hospital, 11 without receiving a transplant. Hydrocortisone therapy permitted rapid weaning of vasopressor therapy but did not affect survival. CONCLUSIONS:: Children with end-stage liver disease are at risk for hepatoadrenal syndrome and should have their cortisol levels monitored since clinical manifestations may not be diagnostic.
Gabriel J Hauser; Hannah M Brotzman; Stuart S Kaufman
Related Documents :
15301788 - Essential fatty acids and phospholipase a2 in autistic spectrum disorders.
21663878 - Plasmodium vivax malaria: is it actually benign?
21737158 - Impact of diastolic dysfunction on the outcome of catheter ablation in patients with at...
12088608 - Antioxidant enzymes and lipid peroxidation in the scalp of patients with alopecia areata.
18178408 - Role of implantable cardioverter-defibrillators in patients with methadone-induced long...
15253688 - Clinical update on alefacept: consideration for use in patients with psoriasis.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-15
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  -     ISSN:  1529-7535     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Division of Pediatric Critical Care and Pulmonary Medicine (GJH), Department of Pediatrics (SSK), Georgetown University Hospital, Georgetown University School of Medicine (HMB), and Georgetown Transplant Institute (SSK), Washington, DC.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Ventricular assist device as a bridge to transplant, and extracorporeal membrane oxygenation for pri...
Next Document:  Mediators of initial acute and later posttraumatic stress in youths in a pediatric intensive care un...