title: Postoperative acute adrenal failure caused by transient corticotropin deficiency.
abstract: BACKGROUND
  Acute adrenal insufficiency after a surgical procedure or trauma is rarely reported. In recent years, however, we have treated seven patients with acute primary adrenal insufficiency and three patients with secondary adrenal insufficiency who presented with shock after a surgical procedure or trauma. The standard cosyntropin test was misleading for the diagnosis of corticotropin deficiency.
  
  
  METHODS
  In this study we measured serum cortisol in patients older than 65 years who had unexplained hypotension after an abdominal surgical procedure. If the serum cortisol was less than 15 micrograms/dl, we performed 1 microgram and standard (250 micrograms) cosyntropin tests and measured thyroxine, thyrotropin, leutinizing hormone in all patients, and free testosterone in men.
  
  
  RESULTS
  We identified five (5%) of 105 patients after an operation who displayed evidence of corticotropin deficiency (i.e., serum cortisol < 15 micrograms/dl during hypotension, prompt hemodynamic improvement with glucocorticoid therapy, and normal response to standard dose cosyntropin). In these patients 1 microgram cosyntropin produced abnormal peak cortisol levels. These patients also had thyrotropin or leutinizing hormone deficiency. After recovery the low hormone levels improved or became normal.
  
  
  CONCLUSIONS
  Postoperative adrenal insufficiency, particularly that caused by transient corticotropin deficiency, is more common in patients than currently recognized. The 1 microgram cosyntropin test may be more sensitive than the standard test for identifying secondary adrenal insufficiency.
authors.affiliation: Department of Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wis.
authors.forename: W H
authors.initials: WH
authors.lastname: Merry
authors.forename: R H
authors.initials: RH
authors.lastname: Caplan
authors.forename: G G
authors.initials: GG
authors.lastname: Wickus
authors.forename: R H
authors.initials: RH
authors.lastname: Reynertson
authors.forename: W A
authors.initials: WA
authors.lastname: Kisken
authors.forename: T H
authors.initials: TH
authors.lastname: Cogbill
authors.forename: J
authors.initials: J
authors.lastname: Landercasper
mesh_terms: D000208:Acute Disease; D000309:Adrenal Insufficiency / Q000209:etiology*; D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D000368:Aged; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D013972:Thyrotropin / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D006854:Hydrocortisone