Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients

Archives of Surgery
Bryan A CottonPatrick G Arbogast

Abstract

Timely diagnosis and treatment of adrenal insufficiency (AI) dramatically reduces mortality in trauma patients. We sought to identify risk factors and populations with a high risk of developing AI. Retrospective registry study. Academic level I trauma center. All trauma patients in the intensive care unit who underwent cosyntropin stimulation testing (CST) for presumed AI from January 1, 2002, through December 31, 2004. Cosyntropin stimulation testing, in which response was defined as an increase of 9 mug/dL (248 nmol/L) or more in cortisol level. Risk factors for developing AI in critically ill trauma patients. In 137 patients, CST was performed; 83 (60.6%) were nonresponders and 54 (39.4%) were responders. Age, sex, race, trauma mechanism, Injury Severity Score, and Revised Trauma Score were not statistically different between the groups. Rates of sepsis/septic shock, mechanical ventilation, and mortality were also similar between the 2 groups. However, rates of hemorrhagic shock on admission (45 [54%] vs 16 [30%]), requirement of vasopressor support (65 [78%] vs 28 [52%]), and etomidate exposure (59 [71%] vs 28 [52%]) were all significantly higher in the nonresponder group (P < .01). The increased risk of AI remained after c...Continue Reading

Citations

Jul 30, 2014·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Viktor BartanuszDaniela Jezova
Jul 12, 2012·Critical Care : the Official Journal of the Critical Care Forum·Nienke MolenaarA B Johan Groeneveld
Jan 1, 2008·Journal of Emergencies, Trauma, and Shock·Timothy C Hardcastle
Jan 3, 2012·BMC Clinical Pharmacology·Antoine J CherfanYaseen M Arabi
Nov 3, 2012·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Daniel ScherzerJoseph D Tobias
Apr 21, 2010·Der Anaesthesist·M BernhardM A Weigand
Jan 26, 2012·Der Unfallchirurg·C Waydhas, UNKNOWN German Society of Trauma Surgery (DGU)
Mar 5, 2011·Intensive Care Medicine·Stewart G AlbertAyesha Rather
Jun 19, 2013·Medicina intensiva·E Celis-RodríguezUNKNOWN Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva
Jul 24, 2010·Chest·Dayton DmelloGeorge M Matuschak
Sep 23, 2008·The Journal of Surgical Research·Igor V VoskresenskyBryan A Cotton
Nov 7, 2015·Saudi Journal of Anaesthesia·Joseph D Tobias
Jun 4, 2015·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·S L ZettervallJ R Dunne
Nov 22, 2013·The Annals of Pharmacotherapy·Joanna L StollingsDaniel R Brown
Dec 21, 2016·Annals of Emergency Medicine·Cameron P UpchurchWesley H Self
Jan 7, 2017·European Journal of Pharmaceutical Sciences : Official Journal of the European Federation for Pharmaceutical Sciences·Jun YangWensheng Zhang
Mar 26, 2011·Journal of Intensive Care Medicine·Christian ConsilvioGeoffrey K Lighthall
Jun 10, 2010·The Annals of Pharmacotherapy·Stephanie B Edwin, Pamela L Walker
Jan 3, 2012·Journal of Burn Care & Research : Official Publication of the American Burn Association·Kencee K GravesAmalia Cochran
Jul 11, 2008·Current Opinion in Critical Care·Arie Bastiaan Johan GroeneveldBert Beishuizen
Nov 6, 2009·European Journal of Anaesthesiology·David C RayDermot W McKeown
Mar 10, 2019·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Steven M Lemieux, Alexander R Levine
Nov 9, 2012·The Journal of Trauma and Acute Care Surgery·Julie MayglothlingUNKNOWN Eastern Association for the Surgery of Trauma
Oct 11, 2013·Anesthesia and Analgesia·Joshua M TobinAlbert J Varon
Aug 22, 2012·European Journal of Anaesthesiology·David C Ray, Dermot W McKeown
May 13, 2009·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Barry P Markovitz
Sep 12, 2012·European Journal of Anaesthesiology·Beatrice de la GrandvilleBernhard Walder
Jun 6, 2020·Anesthesiology·Gladness Dakalo NethatheCharles Feldman
Jan 29, 2013·The Journal of Trauma and Acute Care Surgery·Deborah M SteinThomas M Scalea
Mar 25, 2017·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Joseph M LaRochelleJanet L Rossi
Jan 9, 2015·The Cochrane Database of Systematic Reviews·Eric A BruderCorinne Hohl
Mar 24, 2017·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Amir H HamrahianUNKNOWN AACE Adrenal Scientific Committee
Feb 28, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Arasch WafaisadeMichael Gäßler
Nov 29, 2012·The Journal of Trauma and Acute Care Surgery·Shana L BallowMichelle Chang
Jun 9, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Samhati MondalMichael Mazzeffi
Dec 31, 2020·Anesthesiology·Gladness Dakalo NethatheCharles Feldman

❮ Previous
Next ❯

Related Concepts

Related Feeds

Addison Disease

Addison's disease, also known as primary adrenal insufficiency and hypocortisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones. Discover the latest research on Addison's disease here.