The purpose of this study is to determine the incidence of adrenal dysfunction in pediatric patients diagnosed with septic shock and to compare the clinical outcome of children with and without adrenal dysfunction. We hypothesize that children diagnosed with septic shock and adrenal dysfunction have increased mortality and MOSF compared with those with septic shock and normal adrenal response. Fifty-six patients ranging in age from one month to 18 years diagnosed wih septic shock and who have an arterial or central venous catheter in place will be eligible for enrollment in the study. Within 8 hours of admission to the PICU, and after written informed consent is obtained, an ACTH stimulation test will be performed on each patient enrolled in the study. A blood sample for a baseline cortisol and ACTH level will be drawn and recorded at time 0. After these baseline labs are drawn, an intravenous infusion of ACTH (Cosyntropin, Cortrosyn(R)) will be started. Additional cortisol levels will then be obtained at 30 and 60 minutes. Treatment with steroid replacement therapy will be at the discretion of the primary care team. (If the patient is given steroid therapy, then this patient will be excluded from the outcome analysis part of this study.) While hospitalized in the PICU, patient laboratory, hemodynamic data, and outcome data along with daily use of inotropes will be recorded. Mortality rate, PRISM, and outcome data will be compared between patients to with adrenal dysfunction vs. those with normal adrenal response. We have currently enrolled 5 patients out of the necessary 56 study participants.
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