Relative adrenal insufficiency in critically ill hematology patients

Aim

Sepsis is the most common cause of death of hematology patients in intensive care units. The adrenal gland is potentially involved in sepsis. Impaired functions of the adrenal gland can be caused by hemorrhage, tumor infiltration, drugs and suppression after glucocorticoid treatment. The goal of the study was to evaluate adrenal functions in a group of critically ill hematology patients.

Patients and methods

Forty critically ill patients with hematological disease, mean age 57 ± 14 years, 22 of them women. Mortality was 48%. The mean APACHE II score was 37 (22–48). We performed a 250 μg short intravenous corticotropin test and we determined plasma concentrations of cortisol before and 30 and 60 min after the test. According to the results patients were classified as having adrenal insufficiency or not.

Results

The incidence of the adrenal insufficiency depends on the criteria used. Using a basal cortisol level lower than 414 nmol/l (15 mg/dl), the incidence of adrenal insufficiency was 27.5% (11 patients). Using a basal cortisol level or cortisol response to corticotropin lower than 250 nmol/l, the incidence of adrenal insufficiency was 60% (20 patients). When we use both these criteria, the incidence of adrenal insuficiency was 12.5% (five patients) and all these patients died. Patients with adrenal insufficiency had higher mortality.

Conclusion

There is a high incidence of adrenal insufficiency in critical ill hematology patients. These patients should undergo evaluation of adrenal functions to reveal patients with a need of hydrocortisone treatment.