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Journal of the Korean Pediatric Society 2002;45(5):654-658.
A Change of Adrenal Androgen and Cortisol in Kawasaki Disease
Sun-Hee Lee, Jae-Hong Yu, Hong-Ryang Kil
Department of Pediatrics, College of Medicine, Chungnam National University, Daejon, Korea
가와사끼병에서 부신 안드로겐과 코티솔의 변화
리선희, 유재홍, 길홍량
충남대학교 의과대학 소아과학교실
Correspondence:  Jae-Hong Yu,
Email: jhongyu@cuvic.cnu.ac.kr
Abstract
Purpose
: Endocrine and immune systems are connected and interdependent. Adrenal glands play an important role in this network and control the balance between serum levels of dehydroepiandrosterone sulfate(DHEAS) and cortisol. These steroids have an antagonistic effect on the T cell progression into Th1 and Th2 cells and on the induction of correlated interleukins. Therefore we evaluated the role of adrenal androgen and cortisol as immune modulators in Kawasaki disease(KD) with changes of T cell immunity.
Methods
: From April to August in 2001, we examined serum DHEAS and 24 hour urine free cortisol(F) before administration of immunoglobulin and steroids by radioimmunoassay in 14 KD patients. It's clinical severity was determined by Harada score and coronary lesion.
Results
: The age of the patient group ranged from 4 months to 4 years; its average age was 2.3 years. Three patients(21.4%) were below 1 year, 2(14.3%) between 1 and 2 years, 5(35.7%) between 2 and 3 years, 4(28.6%) between 3 and 4 years of age. Male to female ratio was 1:1.3. DHEAS was significantly decreased in patients(11.1±6.0 μg/dL) more than controls(81.6±13.3 μg/dL)(P<0.05). Twenty-four hour urine free cortisol was significantly increased in patients(36.9±21.9 μg/dL) more than controls(13.6±5.5 μg/dL)(P<0.05). Ratio of DHEAS/F was decreased remarkably in patients(0.33±0.20) more than controls(6.65±2.56)(P=0.016). There was no difference between ratio of DHEAS/F and Harada score, but its ratio was very low in patients with coronary aneurysm.
Conclusion
: These data demonstrate that there are changes of DHEAS and cortisol in acute stage of KD and the dis-equilibrium between two steroids may be relevant in the T cell immune response induction of Kawasaki disease. These changes support the use of DHEAS/F ratio as one of the predictive factors of coronary arteries complication.
Key Words: DHEAS/24 hr urine free cortisol ratio, Kawasaki disease


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