Assessment of adrenal function in the initial phase of XXXX .

@entity1 @entity4545 @entity1887 @entity409 @entity2339 @entity701 @entity7135
OBJECTIVE: To determine the status of the @entity2339 in @entity1 who had @entity7135 and were admitted to 2 regional pediatric intensive care units. METHODS: Sixty-five @entity1 (34 @entity1 ; median age: 2.5 years; range: 0.2-15 years) had @entity701 and @entity4545 (ACTH) levels measured on admission, then at 8 AM and 8 PM during the next 48 hours. At 48 hours, a low-dose short Synacthen test (LDST) (500 ng of 1-24 corticotropin/m2) was performed in 42 @entity1 (19 @entity1 ). Normal ranges for 8 AM @entity701 and ACTH levels in unstressed @entity1 were 140 to 500 nmol/L and 2 to 11.3 pmol/L, respectively. @entity1887 ( @entity1887 ) was defined as a peak @entity701 <500 nmol/L on the LDST or an 8 AM @entity701 value <140 nmol/L. RESULTS: Five (7.7%) of the 65 @entity1 died, including 1 with primary @entity1887 . @entity701 levels were elevated on admission (median: 1122 mmol/L; range: 65-2110 nmol/L) with 81% of values more than the 8 AM normal range. The median ACTH level on admission was within the 8 AM normal range, but 40% of values were more than the 8 AM normal range. However, 7% and 8% of @entity701 and ACTH values, respectively, were less than the normal range. Both @entity701 and ACTH levels fell thereafter and showed no diurnal variation during the 48-hour profile. Six (14%) of the 42 failed the LDST. These @entity1 had significantly lower mean 8 AM @entity701 values than those with a normal peak value on the LDST. Five additional @entity1 who did not have the LDST had 8 AM @entity701 values <140 nmol/L. In the diagnosis of @entity1887 , the sensitivity of the 8 AM mean @entity701 value at a cutoff of 400 nmol/L, judged against the LDST, was 83%; the specificity was 81%. CONCLUSIONS: During the initial phase of @entity7135 , raised @entity701 and ACTH levels indicate an appropriate stress response within the @entity2339 . However, a substantial subpopulation (11 [16.9%] of 65) has evidence of @entity409 during this period. Morning @entity701 values in the initial phase of @entity7135 could be used as a potential early index of @entity1887 .
