title: The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate.
abstract: BACKGROUND
  Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus. The influence of etomidate administration on the incidence of relative adrenal insufficiency in patients with septic shock has not been formally investigated. The objective of this study was to determine the incidence of relative adrenal insufficiency in patients with septic shock after etomidate administration compared with patients with septic shock who did not receive etomidate.
  
  
  METHODS
  In this retrospective study, 152 adults with septic shock who had a consyntropin stimulation test between March 2002 and August 2003 in a tertiary medical center were included. Relative adrenal insufficiency was defined as a rise in serum cortisol <or= 9 microg/dl after the administration of 250 microg of consyntropin. Patients were divided into those who did and those who did not receive etomidate before the stimulation test. The proportion of patients with relative adrenal insufficiency in these two groups was compared using Fischer's exact test. A P of value < 0.05 was considered statistically significant.
  
  
  RESULTS
  The mean age of the patients was 64 years, 59% of patients were male, 97% of patients were white and their hospital mortality rate was 57%. Thirty-eight patients (25%) received etomidate before the cosyntropin stimulation test, and the median (interquartile range) time interval between the administration of the drug and the test was 7 (4-10) hours. The incidence of relative adrenal insufficiency was 76% in the patients who received etomidate compared with 51% in the patients who did not (P = 0.0077).
  
  
  CONCLUSIONS
  The incidence of relative adrenal insufficiency in patients with septic shock is increased when the stimulation test is performed after the administration of etomidate.
authors.affiliation: Department of Cardiothoracic Anesthesiology, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA. mohammz@ccf.org
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Mohammad
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Javier D
authors.initials: JD
authors.lastname: Finkielman
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D005045:Etomidate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D006854:Hydrocortisone; D005045:Etomidate