Affiliations: Critical Care Medicine, Children's Hospital of
Pittsburgh, University of Pittsburgh Medical Center, PA, USA | Pediatric Critical Care, McMaster Children's Hospital,
McMaster University, Hamilton, Ontario, Canada | Acute and Critical Care Programs, Department of
Pediatrics, University of British Columbia, Vancouver, British Columbia,
Canada
Note: [] Correspondence: Dr. Karen Choong, Pediatric Critical Care,
McMaster Children's Hospital, Hamilton Health Sciences, Room 1S 1, 200 Main
St. West, Hamilton, On, L8N 3Z5, Ontario, Canada. Tel.: +1 905 521 2100 ext
75617; E-mail: [email protected]
Abstract: Endocrine dysfunction is common in severe sepsis and is associated
with increased morbidity and mortality risk. Clinical detection of this
heterogenous disorder is limited, and the accuracy of laboratory diagnosis is
complicated by the limitations in hormonal assays and the variable definitions
used in its diagnosis. This article reviews the common hormone therapies that
have been evaluated in the critically ill patient with sepsis, namely
corticosteroids, vasopressin and insulin. There are numerous adult clinical
trials in this area, some of which have revealed conflicting results. Pediatric
data is much more limited. We present current recommendations for hormone
therapy in adults and children, but caution that further study is needed to
better understand the dynamic and complex endocrine responses during septic
shock, and to develop improved methods for diagnosis and monitoring of patient
response, so that we can determine not only which therapies to use, but how, in
what combinations, and in which patients.
