Relative adrenal insufficiency in patients with severe acute pancreatitis

Background

Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with relative adrenal insufficiency and to describe how adrenal responsiveness affects outcome.

Methods

In a prospective observational multicenter study, a short Synacthen test (SST) was performed within 5 days after admission to the hospital in 25 patients with severe acute pancreatitis, after signed informed consent was obtained. The incidence of RAI, defined as an increment after SST of less than 9 μg/dl, was the primary endpoint of the study. Serum cortisol was measured at baseline and 30 and 60 minutes after 250 μg adrenocorticotropic hormone administration.

Results

The median baseline cortisol level was 26.6 μg/dl, and increased to 43.2 μg/dl and 48.8 μg/dl after 30 and 60 minutes, respectively. RAI was found in 16% of all patients, and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from day 4 through day 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Mortality was significantly higher in patients with RAI (75% vs 10%, P = 0.016). Patients who died had a lower increment in cortisol levels after the SST than patients who survived.

Conclusion

RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with an increased mortality rate.