Relative Adrenal Insufficiency Is Associated With Prolonged Postoperative Hemodynamic Instability

The Annals of Thoracic Surgery
Amine MazineDenis Bouchard

Abstract

We assessed the hypothesis that a significant proportion of patients undergoing cardiac surgery have postoperative relative adrenal insufficiency (RAI), and that this puts them at higher risk of persistent hemodynamic instability. A prospective study included 135 patients who underwent cardiac surgery using cardiopulmonary bypass between July 2006 and December 2007. Adrenal function was assessed 36 hours after surgery using a 1-μg cosyntropin (adrenocorticotropic hormone [ACTH]) stimulation test. Relative adrenal insufficiency was defined as a peak cortisol level inferior to 500 nmol/L or an increase in cortisol of less than 250 nmol/L, or both, compared with baseline. The primary endpoint was hemodynamic instability at 48 hours after surgery, defined as persistent requirement for any vasoactive drug. The secondary endpoint was long-term survival. Postoperative RAI was diagnosed in 75 patients (56%). Compared with patients who showed a normal response to the ACTH stimulation test, patients with RAI had significantly higher rates of hemodynamic instability at 48 hours (40% versus 22%, p = 0.03). On multivariable analysis, adrenal response to the ACTH test was a significant independent predictor of hemodynamic instability at 48 h...Continue Reading

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.