title: Adrenal insufficiency in severe West Nile Virus infection.
abstract: OBJECTIVE
  To explore adrenal function in severe West Nile virus (WNV) infection.
  
  
  METHODS
  Prospective interventional cohort study in a medical ICU of a teaching hospital.
  
  
  METHODS
  Ten consecutive patients (seven men, mean age 64+/-12years, mean SAPS II 26+/-6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39+/-1 degrees C) and altered mental status (mean Glasgow Coma Score 11+/-2). Mean SOFA score was 9+/-2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation.
  
  
  METHODS
  A short corticotropin test was performed in each patient to assess the adrenal function.
  
  
  RESULTS
  Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 microg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 microg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 microg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived.
  
  
  CONCLUSIONS
  Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.
authors.affiliation: CHU Fatouma Bourguiba, Intensive Care Unit, 5000, Monastir, Tunisia. f.abroug@rns.tn
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Lamia
authors.initials: L
authors.lastname: Ouanes-Besbes
authors.forename: Islam
authors.initials: I
authors.lastname: Ouanes
authors.forename: Noureddine
authors.initials: N
authors.lastname: Nciri
authors.forename: Fahmi
authors.initials: F
authors.lastname: Dachraoui
authors.forename: Fadhel
authors.initials: F
authors.lastname: Najjar
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000821:virology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014901:West Nile Fever / Q000150:complications* / Q000401:mortality
chemical_list: D000324:Adrenocorticotropic Hormone