title: Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock.
abstract: OBJECTIVE
  To characterise the plasma cortisol profile and adreno-cortial responsiveness (short Synacthen test) of patients in septic shock.
  
  
  METHODS
  Retrospective assessment using case-notes and ICU charts.
  
  
  METHODS
  University teaching hospital ICU.
  
  
  METHODS
  68 septic shock patients with plasma cortisol and/or short Synacthen test measured at ICU-admission or onset of shock post ICU-admission. Patients were identified from a total population of 155 patients who had PCL and/or SST measured over a 4.5 year period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patients with septic shock had a plasma cortisol ranging from 210-8900 nmol/l and mortality of 56%. There were 22 (32%) below (low) and 46 (68%) above (high) a 'critical' plasma cortisol of 500 nmol/l. Using stepwise logistic regression, mortality was adequately predicted by and increased with, increasing plasma cortisol and onset of shock remote from ICU-admission. Short Synacthen tests were available in 33 patients: 11 responders (cortisol increment > 200 nmol/l above baseline 30 min after 0.25 mg intravenous Synacthen) and 22 hypo-responders. Mortality in patients was adequately predicted by and increased with a decrease in cortisol increment post-Synacthen. Thirteen patients (plasma cortisol 606 +/- [SD] 297 nmol/l) had complete haemodynamic profiles before inotropic therapy; no relationship was demonstrated between plasma cortisol and circulatory variables. Follow-up revealed no cases of Addison's disease.
  
  
  CONCLUSIONS
  In septic shock, 'hypocortisolaemia' is not uncommon and does not predict a high mortality; adrenocortical hypo-responsiveness may be associated with poor outcome.
authors.affiliation: Intensive Care Unit, Queen Elizabeth Hospital, Woodville, South Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Moran
authors.forename: M J
authors.initials: MJ
authors.lastname: Chapman
authors.forename: M S
authors.initials: MS
authors.lastname: O'Fathartaigh
authors.forename: A R
authors.initials: AR
authors.lastname: Peisach
authors.forename: P R
authors.initials: PR
authors.lastname: Pannall
authors.forename: P
authors.initials: P
authors.lastname: Leppard
mesh_terms: D000302:Adrenal Cortex / Q000378:metabolism; D000324:Adrenocorticotropic Hormone; D000368:Aged; D001774:Blood Chemical Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone