Association between circulating cortisol and ACTH and severity of dengue infection in adult patients

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.