Study of adrenal function in children with meningitis

CORTICOSTEROIDS were introduced into the therapeutic armamentarium in 1949, and initially there was considerable enthusiasm regarding their possible uses in infectious diseases. One authority in a review in 1957 commented as follows: "I am prepared to state that the use of ACTH or adrenocorticosteroids on a short term basis in carefully selected patients with severe infections, often with debilitating and painful complications, not only will frequently contribute to the recovery of patients, but also will at times prevent permanent and disabling sequelae. In preparation for this review over 1,000 reports in the literature have been surveyed, and the more pertinent references have been included." However, initial enthusiasm has abated, and there are now few, if any, situations in which it is universally agreed that steroid treatment of an infectious disease is beneficial. Experience in this field has been acquired largely through the comparison of steroid treated with non-treated controls. In order to help clarify the still debatable issue of whether steroid treatment might be beneficial in cases of fulminating meningococcemia, we have selected another approach. We have attempted to study adrenal function in steroid-untreated patients, and we have compared the data with those obtained in other types of bacterial meningitis and in aseptic meningoencephalitis. METHODS Patients Studied Unselected patients (Tables I-IV) admitted for meningitis were studied at The Children's Hospitals of The District of Columbia and of Pittsburgh, and The Children's Medical and Surgical Center of Baltimore. House officers at those centers notified the authors at the time of, or shortly after, the patients' admission. Most patients were started on the study immediately after admission, but some of them were included after varying time lapses.