Role of procalcitonin in diagnostics of acute adrenal insufficiency

Introduction

Acute adrenal insufficiency (AAI) with refractory arterial hypotension (RAH) is a rare but life-threatening complication after neurosurgery. Clinical and laboratory diagnostics of AAI are difficult and its treatment must be begun immediately. Hyperthermia, leukocytosis and increased C-reactive protein (CRP) are commonly revealed in these patients. RAH and the other abovementioned symptoms are also typical for patients with septic shock onset. These delayed the timely beginning of adequate therapy. We undertook a pilot study to elucidate the role of procalcitonin (PCT) in diagnostics of AAI.

Methods

RAH developed in three patients postoperatively: one patient had an aneurism of the anterior cerebral artery, one patient cavernoma of the midbrain, and one patient clival chordoma. After hemodynamic insult, clinical blood analysis was performed. PCT (LUMItest PCT; BRAHMS), CRP, electrolytes, glucose and cortisol were investigated. X-ray investigation, urine and liquor examinations were performed.

Results

Patients had hyperthermia (>38°C), increased CRP (>90 mg/l), leukocytosis (>11 × 10⁹/l) in two patients and leucopenia in one case. Two patients had PCT < 0.5 ng/ml and 1–1.3 ng/ml (in 2 days after hydrocortisone administration, PCT was 0 ng/ml). There were no revealed sites of infection. Hyponatremia, normoglycemia and tendency to hyperkalemia were founded. Cortisol was normal in two patients and low in one patient. Patients received a stress dose of hydrocortisone with sympathomimetics and infusion. The hemodynamics was stabilized. In 2–3 days patients were weaned from the sympathomimetics. There were no indications for antibiotics.

Conclusion

PCT is normal in patients with AAI despite the presence of hyperthermia, leukocytosis and increased CRP. The results show PCT helps in timely diagnostics and treatment of AAI.