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Serum free cortisol index, free cortisol, and total cortisol in critically ill children

  • Pediatric Brief Report
  • Published:
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Abstract

Background

In critical illness, serum total cortisol (TC) may not adequately reflect adrenal function because of reduced cortisol-binding globulin (CBG).

Aim

To evaluate adrenal function of critically ill children, using free cortisol index (FCI), calculated free cortisol (cFC), and TC levels.

Methods

Thirty-two critically ill and 36 healthy children were included. All children underwent the 1 μg cosyntropin test. TC and CBG levels were measured. Basal and peak TC, FCI, and cFC were determined.

Results

Basal and peak TC, FCI, and cFC of critically ill children were significantly higher than those of the controls. Compared with TC, both basal and peak FCI and cFC of the patients were higher than those of controls to a greater degree. Use of FCI or cFC to diagnose adrenal insufficiency (AI) reduced the frequency of diagnosis of AI by 50%.

Conclusion

FCI and cFC better reflect the dynamic changes of adrenal function of critically ill children.

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Fig. 1
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Abbreviations

HPA:

Hypothalamic–pituitary–adrenal axis

CBG:

Cortisol binding globulin

TC:

Total cortisol

FC:

Free cortisol

FCI:

Free cortisol index

cFC:

Calculated free cortisol

aTC:

Adjusted total cortisol

PICU:

Pediatric intensive care unit

AI:

Adrenal insufficiency

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Acknowledgments

There was no external funding source; the study was supported by research funds from the Faculty of Medicine, Ramathibodi Hospital, Mahidol University. We thank Umaporn Udomsubpayakul for helping with statistical analysis.

Conflicts of interest statement

We have no financial or other conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand

    Preamrudee Poomthavorn, Rojjanee Lertbunrian, Aroonwan Preutthipan, Patcharin Khlairit & Pat Mahachoklertwattana

  2. Faculty of Medicine, Research Center, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand

    Arporn Sriphrapradang

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  1. Preamrudee Poomthavorn
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  2. Rojjanee Lertbunrian
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Correspondence to Preamrudee Poomthavorn.

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Poomthavorn, P., Lertbunrian, R., Preutthipan, A. et al. Serum free cortisol index, free cortisol, and total cortisol in critically ill children. Intensive Care Med 35, 1281–1285 (2009). https://doi.org/10.1007/s00134-009-1480-x

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  • DOI: https://doi.org/10.1007/s00134-009-1480-x

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