Cortisol Secretion in Children With Varicella or Rubeola

SICK patients receiving large doses of glucocorticoids during the incubation or exanthematous stage of chickenpox have an unexpectedly high mortality rate.^1-3 When such a patient has been exposed to or develops varicella, should the glucocorticoid therapy be discontinued, or should the dose be modified? A dilemma exists. Finkel³ has recommended that the drug be discontinued; some suggest that the dose be decreased to physiologic amounts⁴ and others urge that the dose be increased.⁵ We suspected that the problem might be clarified by studying the cortisol secretion of normal children with a viral exanthem. Knowing whether the cortisol secretion is low, normal, or high in these youngsters, one would be justified in prescribing a comparable dose of glucocorticoids for the sick child who had been receiving large amounts. We are reporting the results of such studies in otherwise healthy children with chickenpox or measles and making recommendations