- Paper Report
- Open Access
Cortisol in the ICU
- Richard Venn1
© Current Science Ltd 2000
- Published: 8 June 2000
- Adrenal hypofunction
- intensive care
The incidence of adrenal hypofunction in the critically ill is unknown as there is conflicting evidence in the literature over expected cortisol measurements in these patients and their response to ACTH. Consequently, it is difficult to decide which patients would benefit from substitution therapy. This study attempts to answer these two questions.
Prospective, consecutive critically ill patients (n = 55)
Exclusions: steroid and etomidate therapy; expected ICU stay shorter than 3 days
Morning cortisol measurements (n = 55) and proportion of patients identified with cortisol levels less than 400 or 500 nmol/l (proposed cut off points for adrenal insufficiency)
Short ACTH stimulation test performed (n = 16)
24 h urinary cortisol excretion measured (n = 34)
Thirty-six percent of patients had cortisol levels < 400 nmol/l and 47% < 500 nmol/l. There was a positive correlation between basal plasma cortisol levels and urinary cortisol concentration. Cortisol levels < 400 nmol/l were associated with trauma, cerebral affection, mannitol therapy and ventilatory therapy. Out of 16 patients, nine had an incremental rise in cortisol (< 200 nmol/l) following ACTH stimulation at 30 min and four after 60 min. Eleven of these patients had basal cortisol levels < 400 nmol/l.