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Secondary adrenal insufficiency in the acute phase of pediatric traumatic brain injury.
MedLine Citation:
PMID:  20689911     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
PURPOSE: A high incidence of secondary adrenal insufficiency (AI) has been reported several months after a traumatic brain injury (TBI) in pediatric patients. Data from studies in adults suggest that AI may occur during the acute phase of TBI, with potential negative effects in the management of these vulnerable patients. The aim of this study was to describe the prevalence and the characteristics of AI in the acute phase of pediatric TBI.
METHODS: Adrenal function was systematically evaluated in patients admitted to the pediatric intensive care unit following a TBI. Serial measurements of cortisol (9 samples) and adrenocorticotropic hormone (ACTH) were drawn from the second morning to the third morning post admission. Secondary AI was defined as all cortisols < 200 nmol/l (6 μg/dl) with ACTH < 12 pmol/l.
RESULTS: Twenty-eight patients (2-15 years old) were evaluated. Secondary AI occurred in ten (36%) patients. AI was more frequent in patients with intracranial hypertension (p < 0.05). Patients with AI required longer mechanical ventilation (p < 0.05), and a non-significant trend for a higher Pediatric Logistic Organ Dysfunction score (p = 0.09) and greater norepinephrine dose (p = 0.11) was observed.
CONCLUSIONS: Secondary AI is frequent during the acute phase of pediatric TBI, particularly when intracranial hypertension is present. Systematic assessment of pituitary function after TBI appears to be essential. A randomized clinical trial is warranted to evaluate the benefits of hormonal replacement therapy in TBI patients with AI.
Authors:
Clémentine Dupuis; Sébastien Thomas; Patrice Faure; Armelle Gayot; Amélie Desrumaux; Isabelle Wroblewski; Thierry Debillon; Guillaume Emeriaud
Publication Detail:
Type:  Journal Article     Date:  2010-08-06
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1906-13     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Pediatric Endocrinology, University Hospital of Grenoble, 38043, Grenoble Cedex 9, France.
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