Adrenal function in non-septic long-stay critically ill patients: evaluation with the low-dose (1 micro g) corticotropin stimulation test.
OBJECTIVE
To investigate the adrenal function in non-septic, long-stay critically ill patients.


METHODS
Prospective, consecutive study.


METHODS
General intensive care unit in a university hospital.


METHODS
Forty-three non-septic patients with protracted critical illness.


METHODS
A morning blood sample was first obtained to measure baseline plasma cortisol. Subsequently, 1 micro g of corticotropin (ACTH, Synacthene) was injected intravenously and 30 min later a second blood sample was drawn to determine stimulated plasma cortisol. Patients having a stimulated cortisol level of at least 18 micro g/dl were defined as responders. In 36 patients, morning interleukin-6 (IL-6) was also measured.


RESULTS
Baseline and stimulated plasma cortisol were 16.8+/-4.1 micro g/dl and 21.2+/-5.1 micro g/dl, respectively. Interleukin-6 was high (median 39.3 pg/ml, interquartile range 24.9-86.6 pg/ml) and correlated negatively with stimulated plasma cortisol (r=-0.40, p<0.05). Of the 43 patients studied, 31 patients (72%) were responders and 12 patients (28%) were non-responders to the ACTH stimulation test. Overall, 18 patients died and 25 patients survived to hospital discharge. Non-responders had significantly higher IL-6 levels compared to responders (106+/-73 versus 48+/-42 pg/ml, p<0.05), whereas mortality rate was comparable in the two groups (50% versus 38%, p=0.74).


CONCLUSIONS
Circulating plasma IL-6 levels are high during protracted critical illness, and are partially responsible for the relative adrenal insufficiency found in a subset of severely ill patients.
Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Greece. idimo@otenet.gr
Ioanna
I
Dimopoulou
Ioannis
I
Ilias
Paraskevi
P
Roussou
Alexandra
A
Gavala
Adigoni
A
Malefaki
Ema
E
Milou
Marinos
M
Pitaridis
Charis
C
Roussos
D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003422:Critical Care; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged
D015850:Interleukin-6; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone