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Circulating Aldosterone Levels Are Unexpectedly Low in Children with Acute Meningococcal Disease

E. J. Lichtarowicz-Krynska, T. J. Cole, C. Camacho-Hbner, J. Britto, M. Levin, N. Klein and A. Aynsley-Green

The London Centre for Paediatric Endocrinology and Metabolism and Great Ormond Street Hospital for Children NHS Trust (E.J.L.-K., A.A.-G.), London; Centre for Paediatric Epidemiology and Biostatistics (T.J.C.), Institute of Child Health, London WC1N 1EH; Department of Endocrinology (C.C.-H.), St. Bartholemews Hospital, London EC1A 7BE; Department of Paediatrics (J.B., M.L.), Imperial College School of Medicine, London W2 1PG; and Department of Infectious Diseases and Microbiology (N.K.), Institute of Child Health, London WC1N 1EH, United Kingdom

Address all correspondence and requests for reprints to: E. J. Lichtarowicz-Krynska, Department of Biochemistry, Metabolism, and Endocrinology, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom. E-mail: e.lichtarowicz-krynska{at}ich.ucl.ac.uk.

The incidence of meningococcal disease in childhood has risen over the past decade. Mortality remains high for those who develop septic shock and purpura fulminans. Poor perfusion, hypotension, and loss of intravascular circulating volume may be expected to influence both mineralocorticoid and glucocorticoid secretion.

The aim of the study was to define adrenocortical hormone status at presentation. Sixty children admitted to the pediatric intensive care unit were studied. Children were divided into two groups: group A (n = 31), with meningococcal sepsis, mean age 4.4 yr (range 0.5–14.4), predicted risk of mortality mean 32.3% (range 0.5–99.3%); and group B (n = 29), with other diagnoses (post major surgery and with severe respiratory infections), mean age 4.1 yr (range 0.3–16.3), predicted risk of mortality mean 9.4% (range 0.2–83%). The groups were not significantly different for age. Plasma levels of aldosterone and cortisol were determined by RIA.

The mean plasma aldosterone concentration on admission in group A was 427.5 ± 88.1 pg/ml, with 96.7% of values within the normal range for age for healthy children and were significantly lower than group B mean, 1489.2 ± 244.2 pg/ml (P < 0.0001), with 59.3% of values above the normal range.

In group A there was no correlation with plasma concentrations of sodium, potassium, or volume of colloid infused in the previous 8 h. In group A mean serum cortisol mean values were 799.5 ± 75.9 nmol/liter and in group B cortisol levels were 703.4 ± 78.6 nmol/liter (P = n.s.). We conclude that children with meningococcal disease present with lower plasma aldosterone concentrations than other patients in the pediatric intensive care unit, for which there is no clear explanation. Further work is needed to elucidate the mechanisms underlying this finding and to examine its clinical implications.

This work was supported by Great Ormond Street Hospital for Children NHS Trust who received a proportion of its funding from the NHS Executive; the views expressed in this publication are those of the authors and are not necessarily those of the NHS Executive. E.J.L.-K. was on an ESPE Research Fellowship.

Abbreviations: ACE, Angiotensin-converting enzyme; CV, coefficient of variation; HH, hyperreninemic hypoaldosteronism; PICU, pediatric intensive care unit; PRA, plasma renin activity.

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