Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 7/2009

01-07-2009 | Pediatric Brief Report

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

Authors: Preamrudee Poomthavorn, Rojjanee Lertbunrian, Aroonwan Preutthipan, Arporn Sriphrapradang, Patcharin Khlairit, Pat Mahachoklertwattana

Published in: Intensive Care Medicine | Issue 7/2009

Login to get access

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.
Literature
1.
Widmer IE, Puder JJ, Konig C, Pargger H, Zerkowski HR, Girard J, Muller B (2005) Cortisol response in relation to the severity of stress and illness. J Clin Endocrinol Metab 90:4579–4586PubMedCrossRef
2.
Venkataraman S, Munoz R, Candido C, Witchel SF (2007) The hypothalamic–pituitary–adrenal axis in critical illness. Rev Endocr Metab Disord 8:365–373PubMedCrossRef
3.
Mueller UW, Potter JM (1981) Binding of cortisol to human albumin and serum: the effect of protein concentration. Biochem Pharmacol 30:727–733PubMedCrossRef
4.
Ho JT, Al-Musalhi H, Chapman MJ, Quach T, Thomas PD, Bagley CJ, Lewis JG, Torpy DJ (2006) Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab 91:105–114PubMedCrossRef
5.
Bernier J, Jobin N, Emptoz-Bonneton A, Pugeat MM, Garrel DR (1998) Decreased corticosteroid-binding globulin in burn patients: relationship with interleukin-6 and fat in nutritional support. Crit Care Med 26:452–460PubMedCrossRef
6.
Hamrahian AH, Oseni TS, Arafah BM (2004) Measurements of serum free cortisol in critically ill patients. N Engl J Med 350:1629–1638PubMedCrossRef
7.
Christ-Crain M, Jutla S, Widmer I, Couppis O, Konig C, Pargger H, Puder J, Edwards R, Muller B, Grossman AB (2007) Measurement of serum free cortisol shows discordant responsivity to stress and dynamic evaluation. J Clin Endocrinol Metab 92:1729–1735PubMedCrossRef
8.
Coolens JL, Van Baelen H, Heyns W (1987) Clinical use of unbound plasma cortisol as calculated from total cortisol and corticosteroid-binding globulin. J Steroid Biochem 26:197–202PubMedCrossRef
9.
le Roux CW, Sivakumaran S, Alaghband-Zadeh J, Dhillo W, Kong WM, Wheeler MJ (2002) Free cortisol index as a surrogate marker for serum free cortisol. Ann Clin Biochem 39:406–408PubMedCrossRef
10.
Pollack MM, Ruttimann UE, Getson PR (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116PubMedCrossRef
11.
Beishuizen A, Thijs LG, Vermes I (2001) Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma. Intensive Care Med 27:1584–1591PubMedCrossRef
12.
le Roux CW, Chapman GA, Kong WM, Dhillo WS, Jones J, Alaghband-Zadeh J (2003) Free cortisol index is better than serum total cortisol in determining hypothalamic–pituitary–adrenal status in patients undergoing surgery. J Clin Endocrinol Metab 88:2045–2048PubMedCrossRef
13.
Bonte HA, van den Hoven RJ, van der Sluijs Veer G, Vermes I (1999) The use of free cortisol index for laboratory assessment of pituitary–adrenal function. Clin Chem Lab Med 37:127–132PubMedCrossRef
14.
Arafah BM (2006) Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab 91:3725–3745PubMedCrossRef
15.
Rothwell PM, Udwadia ZF, Lawler PG (1991) Cortisol response to corticotropin and survival in septic shock. Lancet 337:582–583PubMedCrossRef
16.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E (2000) A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 283:1038–1045PubMedCrossRef
17.
Hatherill M, Tibby SM, Hilliard T, Turner C, Murdoch IA (1999) Adrenal insufficiency in septic shock. Arch Dis Child 80:51–55PubMedCrossRef
18.
Pizarro CF, Troster EJ, Damiani D, Carcillo JA (2005) Absolute and relative adrenal insufficiency in children with septic shock. Crit Care Med 33:855–859PubMedCrossRef
19.
Sarthi M, Lodha R, Vivekanandhan S, Arora NK (2007) Adrenal status in children with septic shock using low-dose stimulation test. Pediatr Crit Care Med 8:23–28PubMedCrossRef
Metadata
Title
Serum free cortisol index, free cortisol, and total cortisol in critically ill children
Authors
Preamrudee Poomthavorn
Rojjanee Lertbunrian
Aroonwan Preutthipan
Arporn Sriphrapradang
Patcharin Khlairit
Pat Mahachoklertwattana
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1480-x

Other articles of this Issue 7/2009

Intensive Care Medicine 7/2009 Go to the issue

Brief Report

The significance of non-sustained hypotension in emergency department patients with sepsis

Correspondence

Reply to Oud

Review

Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis

Erratum

Comprehensive safety analysis of concomitant drotrecogin alfa (activated) and prophylactic heparin use in patients with severe sepsis

Brief Report

Occurrence of delirium is severely underestimated in the ICU during daily care

Brief Report

The effects of statin therapy on inflammatory cytokines in patients with bacterial infections: a randomized double-blind placebo controlled clinical trial