24-hour urinary free cortisol in children with paralytic syndromes and chronic pain

Aim of the study
Measurement of 24-hour urinary free cortisol in children with paralytic syndromes with or without chronic pain. Hypothesis: urinary excretion of free cortisol in children with paralytic syndromes and chronic pain differs from urinary excretion of free cortisol in healthy children and children with paralytic syndromes without chronic pain.

Material and methods
92 children were involved in the study. The age of the children ranged from 1 to 7 years. Study group included 64 children (40 boys, 24 girls) with paralytic syndromes, among them 38 children (24 boys, 14 girls) with chronic pain and 26 children (15 boys, 11 girls) without pain. Control group included 28 children (17 boys, 11 girls).

Results
Tetraparesis was observed more often among the children with paralytic syndromes. The ROC-analysis identified the relationship between low and high levels of cortisol in the 24-hour urinary free cortisol in children with paralytic syndromes and especially in those who have chronic pain only in the age group 0-2 years. In 13 children with paralytic syndromes and chronic pain, the trajectory of 24-hour urinary free cortisol was determined, 11 children among them have V level of GMFCS, 5 have pharmacological treatment and all children have more than two sources of pain.

Conclusions
We speculate that in some children with paralytic syndromes, the release of free cortisol in the urine may indicate increased cortisol production as a response to chronic stress (pain), and in some children, adrenal depletion. This opens the prospect of further research in this direction. Therefore, a non-invasive measurement of cortisol in daily urine will affect optimization of environment and monitoring of the child.