Relative adrenal insufficiency in patients with septic shock; a close look to practice patterns

Journal of Critical Care
Naser ElsouriJorge A Guzman

Abstract

To assess patterns of practice in our institution specifically regarding corticosteroid deficiency diagnosis in patients with septic shock. Consecutive adult patients with vasopressor-dependent septic shock admitted to the medical intensive care unit between January 2002 and September 2003 were studied. Relative adrenal insufficiency (RAI) was diagnosed by a random serum cortisol level <or=15 microg/dL or by a random cortisol level between 15 and 34 microg/dL and an increase in response to cosyntropin stimulation test (250 microg) <or=9 microg/dL. Ninety-two patients were included in the study. Mean (+/-SD) age was 59 +/- 18 years. Overall mortality was 53%. Relative adrenal insufficiency was suspected in 44 (48%) patients and confirmed in 25 (57%). Maximal doses of vasopressors were comparable between groups but more patients in whom AI was suspected were on phenylephrine and/or vasopressin and more were treated with activated protein C (P < .05). Diagnosis of RAI was confirmed by a low basal cortisol (<15 microg/dL) in 12 (48%) patients, whereas a diagnosis of RAI was made by a lack of response to the stimulation test in the rest. Relative adrenal insufficiency was diagnosed in half of the patients investigated. Patients with...Continue Reading

References

Oct 1, 1985·Critical Care Medicine·W A KnausJ E Zimmerman
Jan 1, 1995·Intensive Care Medicine·G BouachourP Alquier
Apr 29, 1998·Critical Care Medicine·P E BollaertA Larcan
Mar 4, 2000·JAMA : the Journal of the American Medical Association·D AnnaneE Bellissant
Aug 21, 2002·JAMA : the Journal of the American Medical Association·Djillali AnnaneEric Bellissant
Feb 21, 2003·The New England Journal of Medicine·Mark S Cooper, Paul M Stewart
Feb 6, 2004·Critical Care Medicine·Paul E Marik
Mar 5, 2004·Intensive Care Medicine·R Phillip DellingerM M Levy
Mar 18, 2004·Critical Care : the Official Journal of the Critical Care Forum·Helene PrigentDjillali Annane
Apr 20, 2004·Critical Care Medicine·R Phillip DellingerUNKNOWN Surviving Sepsis Campaign Management Guidelines Committee
Jun 10, 2004·Critical Care Medicine·Jack J M LigtenbergJan G Zijlstra
Dec 24, 2004·Current Opinion in Critical Care·Jack J M Ligtenberg, Jan G Zijlstra

❮ Previous
Next ❯

Citations

May 24, 2011·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Jeffrey Joseph BrunoS Egbert Pravinkumar
Dec 6, 2008·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Kiran HebbarJames D Fortenberry
Jan 6, 2009·Journal of the American Veterinary Medical Association·David M WongWalter H Hsu
Dec 4, 2013·Current Problems in Pediatric and Adolescent Health Care·Laura Santos
Dec 19, 2007·Journal of Critical Care·Jorge A Guzman, Cristina B Guzman
Dec 19, 2007·Journal of Critical Care·Joan M RaurichJosé I Ayestarán
Dec 19, 2014·Clinical Endocrinology·Balasubramanian Venkatesh, Jeremy Cohen
Sep 2, 2009·Memórias do Instituto Oswaldo Cruz·André M JapiassúHugo C Castro-Faria-Neto
Mar 12, 2011·The Veterinary Clinics of North America. Equine Practice·Kelsey A Hart, Michelle H Barton

❮ 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.