Clinical Evaluation of Hypothalamo-Pituitary-Thyroid Axis Hormones in Critically Ill Children. Cross Sectional Study at Zagazig University Children Hospital

Abstract

Background: Critical illness is the medical condition in which a patient requires immediate intensive medical support of vital organ functions in order to survive. Independent of the underlying condition, critical illness is characterized by a uniform dysregulation of the hypothalamic–pituitary–peripheral axes. In the majority of these axes a clear biphasic pattern can be distinguished. Objective: To evaluate serum concentration of adrenocorticotrophin hormone, cortisol, TSH, free T4 in children who had severe illness in Pediatric Intensive Care Unit at Zagazig University Hospitals and El-Ahrar Hospital in Pediatric Intensive Care Unit. Patients and Methods: This study was cross sectional study which conducted at Zagazig University Hospitals and El-Ahrar Hospital in Pediatric Intensive Care Unit on 30 critically ill children. These investigations were measured for all participating patients (serum level of TSH, free T4, adrenocorticotrophin hormone and cortisol). Results: This study was conducted on 30 critically ill children. Mean±SD of age was 12.9±18.0 years. 53% were males. Serum cortisol level was high in about 43% of our critically ill children patients. Serum concentration of adrenocorticotrophin hormone was lower in about 90% in children who had severe illness in pediatric intensive care unit. Serum concentration of TSH was high in about 23% of our critically ill children patients. Serum concentration of free T4 in children was high in about 20% while was lower in 6.7% of our critically ill children patients. Secondary thyroid insufficiency represented 7% (2/30 cases). Conclusion: Secondary thyroid insufficiency represented in 7% of our critically ill children patients. No statistically significant differences in baseline characteristics of the studied critically ill children (stratified according to cortisol level). No statistically significant differences in ACTH, TSH and free T4 levels of the studied critically ill children (stratified according to cortisol level).