Critical Illness-Related Corticosteroid Insufficiency (CIRCI)

Abstract

- Objective: The research aims to study the cases of secondary adrenal insufficiency accepted in the neonatal division of the University Children's Hospital in Damascus, its prevalence, risk factors, methods of diagnosis, management and prognosis.

- Materials and Methods: Cross-Sectional and Retrospective Study, conducted in the neonatal division of the University Children's Hospital in Damascus, and included neonates with secondary adrenal insufficiency with critical illnesses who were admitted to the hospital between 1/8/2019 to 1/8/2021.

- Results: The research included 23 neonates <28 days old (11 males, 12 females, mean age at admission 9.6 days and at diagnosis 13.2 days), gestational age at birth 36.6 weeks, seven were premature, 21 patients with signs of sepsis at admission. Symptoms included: general weakness/depression 82.6%, tachypnea 82.6%, circulatory shock 69.6%, tachycardia 60.9%, nausea/vomiting 52.2%, anorexia 47.8%, hypoglycemia 43.5%, diarrhea 39.1%, hypothermia 30.4%, Fever 4.3%, seizure17.4% and mean arterial tension at diagnosis 59/33 mmHg. At diagnosis all patients had hyponatremia, 39.1% had hyperkalemia, 43.5% had metabolic acidosis, 56.5% had cortisol <15 mcg/dL and 43.5% had cortisol 15-30 mcg/dL. ACTH was measured in 8 patients (cortisol 15-30 µg/dL), and ACTH was <46 pg/dL (mean 25.8 pg/dL). In 8 cases, central adrenal insufficiency was diagnosed, while the type of adrenal insufficiency was not determined in 15 patients. The majority of patients had more than one cause of adrenal insufficiency, but the most common one was sepsis (associated with respiratory infection in 16 cases, and meningitis in two cases), 5 patients had cerebral hemorrhage. Twenty patients died (mean admission-diagnosis period 4.1 days, mean hospitalization period 7.2 days), and three patients survived (median admission-diagnosis 1.3 days, mean hospitalization 9 days). The prevalence of secondary adrenal insufficiency for critical illnesses was 5.7/1000, including central adrenal insufficiency (Pituitary/Hypothalamic) with a prevalence of 1.99/1000.

- Conclusions: Subsequent or critical illness-related adrenal insufficiency constitutes a critical medical condition in neonates poses a diagnostic dilemma, because its symptoms are similar to those of critical illness, and it is associated with a high mortality rate, and early diagnosis improves prognosis.