A comparison of the adrenocortical response during septic shock and after complete recovery.
OBJECTIVE
To compare the adrenocortical response to corticotropin during septic shock and after complete recovery.


METHODS
Prospective clinical study.


METHODS
Multidisciplinary intensive care unit in a university hospital.


METHODS
20 consecutive patients surviving septic shock. All patients met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock. In addition, the presence of high-output circulatory failure with a cardiac index > 41/min per m2 was a criterion for enrollment in the study. Complete recovery from septic shock was defined as discontinuation of any supportive therapies. Severity of illness during septic shock and after recovery was graded using the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system.


METHODS
In each patient, two short corticotropin stimulation tests were done during septic shock and after recovery.


RESULTS
Basal cortisol levels recorded during septic shock and after recovery did not differ (medians: 18.8 vs 18.9 micrograms/dl). However, the response to corticotropin was significantly attenuated during septic shock when compared with the response after recovery (medians: 7.7 vs 14.7 micrograms/dl; p = 0.02). After recovery, patients' stress response was less, as indicated by a reduction in APACHE II scores (medians: 21 vs 5 points; p < 0.01).


CONCLUSIONS
Adrenocortical response to corticotropin is attenuated in patients with septic shock and high-output circulatory failure compared to the response in the much less stressful condition after recovery. The attenuated adrenocortical responsiveness may be explained by effects of circulating mediators from the systemic inflammatory response.
Institut für Anaesthesiologie, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Germany. josef.briegel@ana.med.uni-muenchen.de
J
J
Briegel
G
G
Schelling
M
M
Haller
W
W
Mraz
H
H
Forst
K
K
Peter
D018806:APACHE; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D003289:Convalescence; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications* / Q000503:physiopathology
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone