Adrenal gland evaluation in septic shock patients: preliminary results of the first CT-scan study

Introduction

Although critical-illness-related corticosteroid insufficiency (CIRCI) is common in septic shock patients, its diagnosis and management remain controversial [1, 2]. The recent consensus conference on CIRCI reported that baseline total serum cortisol and that after 250 μg synthetic ACTH is insufficient to evaluate the adrenal response to sepsis [1]. To our knowledge, there is no CT-scan study that has evaluated adrenal gland imaging during septic shock. The aim of our study was to describe the adrenal gland volume evaluated by CT scan during septic shock.

Methods

A single-center study during 1 year. Two groups of patients who benefited from an abdominal CT scan were studied. Patients who presented septic shock, an ACTH test and an abdominal CT scan in the 72 hours before or after the onset of shock were included in the group septic shock (shock +). Patients who benefited from an abdominal CT scan but did not present any shock were included in the group nonshock (shock -). CIRCI was defined as a delta serum total cortisol less than 9 μg/dl after an ACTH test of 250 μg. The main endpoint was the total adrenal gland volume evaluated by CT scan with semiautomatic software (Myriane Intrasense, Montpellier, France).

Results

In the preliminary results we compared 66 patients in septic shock with 20 patients without any shock. In the septic shock group, the Simplified Acute Physiology Score II score was 46 (40 to 56) and mortality in the ICU was 36%. The total adrenal gland volume is presented in Table 1. The ACTH test was not evaluable in four patients in the group septic shock leading us to analyse 62 patients.

Table 1 (abstract P329)

Conclusion

Our preliminary results showed for the first time that in septic shock the total adrenal gland volume is three to four times higher than in nonseptic patients. The diagnosis and outcome impact of this increase volume should be better evaluated.