Adrenocortical function in patients with ruptured aneurysm of the abdominal aorta.
OBJECTIVE
To investigate adrenocortical function in patients with ruptured aneurysm of the abdominal aorta.


METHODS
Prospective clinical investigation.


METHODS
Surgical intensive care unit in a university teaching hospital and intensive care unit in a general hospital.


METHODS
54 patients with a documented rupture of the abdominal aorta.


METHODS
A short adrenocorticotrophic hormone (ACTH) stimulation test was performed.


RESULTS
Patients were studied within 24 h of admission to the hospital. Blood samples for the measurement of cortisol and ACTH were collected at 0800 h. Subsequently 0.25 mg tetracosactrin (Synacthen) was injected i.v. and after 60 min cortisol measurement was repeated. The criterion for a normal short ACTH test was: stimulated or unstimulated cortisol levels > or = 0.55 mumol/l. For the group as a whole, an unstimulated plasma cortisol level of 0.76 mumol/l was comparable to that in other groups of critically ill patients with similar severity of illness. Between survivors and non survivors, significant differences were found between unstimulated plasma cortisol levels (0.70 vs 1.03 mumol/l), stimulated plasma cortisol levels (1.00 vs 1.30 mumol/l), and plasma ACTH levels (72 vs 133 ng/l). One patient did not meet the criteria for normal adrenocortical function: unstimulated plasma cortisol 0.26 mumol/l, stimulated plasma cortisol 0.47 mumol/l.


CONCLUSIONS
In the patients studied with ruptured aneurysm of the abdominal aorta, adrenocortical response was comparable to that in other groups of critically ill patients with similar severity of illness. High cortisol levels were associated with mortality. One patient did not meet the criteria for normal adrenocortical function but survival without steroid treatment.
Braams
R
R
Department of Surgery, University Hospital Utrecht, The Netherlands.
Koppeschaar
H P
HP
van de Pavoordt
H D
HD
van Vroonhoven
T J
TJ
D018806:APACHE; D000309:Adrenal Insufficiency / Q000097:blood* / Q000139:chemically induced; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001012:Aorta, Abdominal; D001019:Aortic Rupture / Q000097:blood* / Q000601:surgery; D003366:Cosyntropin / Q000494:pharmacology; D016638:Critical Illness; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006728:Hormones / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000139:chemically induced; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D006728:Hormones; D003366:Cosyntropin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D005045:Etomidate