Association between Circulating Cortisol and ACTH and Severity of Dengue Infection in Adult Patients
Sura-Amornkul S, MD1, Pitabut N, PhD2,3, Pholtawornkulchai K, MD1, Matangkasombut P, MD, PhD4, Sakuntabhai A, MD, PhD5,6, Singhasivanon P, MD, PhD7
Affiliation : 1 Department of Medicine Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand 2 Office of Research Services, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand 3 Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand 4 Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand 5 Functional Genetics of Infectious Diseases Unit, Institut Pasteur, F-75724 Paris Cedex 15, France 6 Centre National de la Recherche Scientifique (CNRS), URA3012, Paris, France 7 Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok , Thailand
Objective : To study the kinetics of endocrine changes in adult patients with dengue hemorrhagic fever (DHF) and dengue fever (DF)
and association to disease severity.
Materials and Methods : This hospital-based observational clinical study involved 48 adult patients, 32 with DHF and 16 with DF,
who presented with clinical features and positive serological testing for dengue infection on the day of diagnosis (D1). Serial
circulating ACTH and cortisol concentrations were determined on D1, day of defervescence (Ddef), day 1 of convalescence (DC1 or
24 h after Ddef), day 2 of convalescence (DC2 or 48 h after Ddef), at 2-week follow-up (F1), and 2-month follow-up (F2).
Results : The median cortisol concentration in the DHF group was higher on D1 than that at F2. This was not found in patients with
DF who had no difference of median cortisol concentration at D1 and F2. The median ACTH concentrations in both DHF and DF
groups were low on D1 and trended toward recovery at F2. There was association between circulating ACTH and cortisol
concentrations at D1 in patients with the severity of DHF (r = 0.309, p = 0.042) but not of DF.
Conclusion : The ACTH and cortisol responses were associated with severity of dengue infection and recovery after 2 months.
Keywords : ACTH, Cortisol, Dengue fever, Dengue hemorrhagic fever
