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J Pediatr Infect Dis 2009; 04(02): 119-126
DOI: 10.3233/JPI-2009-0153
Review Article
Georg Thieme Verlag KG Stuttgart – New York

Hormonal therapies in septic shock

Kate Felmet
a   Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, PA, USA
,
Karen Choong
b   Pediatric Critical Care, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
,
Niranjan Kissoon
c   Acute and Critical Care Programs, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
› Author Affiliations
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Further Information

Publication History

26 August 2008

30 October 2008

Publication Date:
28 July 2015 (online)

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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.

Keywords

Hormone - corticosteroids - vasopressin - insulin - sepsis