High Cortisol Observed in Children With Acute Illnesses, No Glucocorticoid Deficiency

Close up of saline intravenous (iv) drip in a child’s patient hand. Health care and people concept. Vintage tone.
Researchers assessed variations in cortisol concentrations among children and adolescents with acute illnesses and no history of glucocorticoid deficiency.

Results of a systematic review showed that circulating cortisol concentrations were increased during acute illness among children and adolescents with no history of glucocorticoid deficiency. These findings were published in JAMA Network Open.

Investigators at the University of Manchester in the United Kingdom searched publication databases through June 2020 for studies that assessed endogenous cortisol concentrations in pediatric patients with acute or critical illnesses. A total of 15 studies comprising 864 patients were included in the analysis, of which 5 included a group of control patients (n=175).

Among patients with an acute illness, 123 had bronchiolitis, 430 had sepsis, 52 had severe gastroenteritis, 44 had critical illness unrelated to sepsis, and 40 had meningitis.  

The researchers found that cortisol concentrations were increased among patients (mean age, 4.25 years) with any acute illness (weighted mean, 29.39±28.12 μg/dL) vs patients (mean age, 2.28 years) in the control groups (weighted mean, 10.44±5.86 μg/dL).

Stratified by acute illness, cortisol concentrations were lowest in patients (mean age, 0.42 years) with mild or moderate bronchiolitis (weighted mean, 16.14±10.12 μg/dL) and highest among patients (mean age, 3.54 years) with bacterial meningitis (weighted mean, 46.42±22.24 μg/dL).

The greatest difference in cortisol concentrations was observed between patients with meningitis and control patients (weighted mean difference [WMD], 30.90 μg/dL; 95% CI, 24.57-37.23), with the smallest difference observed between those with sepsis who did and did not survive (WMD, 5.65 μg/dL; 95% CI, -10.72 to 22.02).

Limitations were the inclusion of only hospital-based studies, the small number of patients in the control groups, and the lack of a standardized method for reporting cortisol concentrations.

“Robust studies are required to examine whether comparable [cortisol] levels need to be achieved with exogenous GC treatment when children and adolescents with [glucocorticoid] deficiency experience different acute illnesses,” the researchers concluded.

Editor’s Note: The original version of this article included an error in the mean age of patients with bacterial meningitis in the fifth paragraph; the correct mean age is 3.54 years. The article was corrected on July 22, 2022, to reflect this.


Rezai M, Fullwood C, Hird B, et al. Cortisol levels during acute illnesses in children and adolescents: a systematic review. JAMA Netw Open. 2022;5(6):e2217812. doi:10.1001/jamanetworkopen.2022.17812