Where in the world is WALDO (Why Adrenal Levels Defy Observation)? Hemodynamic correlates of serum cortisol in neonates after cardiopulmonary bypass.

摘要

Perhaps Dr Einstein would feel differently if he were facing a true mystery, like the hypotha-lamic-pituitary-adrenal axis in infants after cardiac surgery, rather than something relatively simple, like the nature of the universe. Indeed, there are few areas in the understanding of critically ill patients as controversial as the management and diagnosis of adrenal insufficiency. Studies in sepsis have shown both benefit and detriment with the use of steroid replacement therapy for presumed adrenal insufficiency with the most recent large randomized controlled trial in adults demonstrating no benefit irrespective of the demonstration of so-called relative adrenal insufficiency (1-4). In infants, we are not even sure we know what is normal and abnormal with regard to the adrenocortical stress response let alone whether when exogenous steroids should be used and when.