Relative adrenal insufficiency in patients with severe acute pancreatitis.
OBJECTIVE
Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with RAI and to describe how adrenal responsiveness affects outcome.


METHODS
Prospective observational multicenter study.


METHODS
Twenty-five patients with severe acute pancreatitis.


METHODS
A short Synacthen test (SST) was performed within 5 days after admission to the hospital. The incidence of RAI, defined as an increment after SST of less than 9 microg/dl was the primary endpoint of the study. Serum cortisol was measured at baseline and at 30 and 60 min after administration of 250 microg adrenocorticotropic hormone.


RESULTS
Median baseline cortisol level was 26.6 microg/dl, and increased to 43.2 microg/dl and 48.8 microg/dl after 30 min and 60 min respectively. RAI was found in 16% of all patients and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from days 4 to 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Twenty-eight-day mortality was significantly higher in patients with RAI (75% vs. 5%, p =0.007). Patients who died had a lower increment in cortisol levels after the SST than patients who survived.


CONCLUSIONS
RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with increased mortality.
De Waele
Jan J
JJ
Intensive Care Unit 1K12-C, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. jan.dewaele@UGent.be
Hoste
Eric A J
EA
Baert
Didier
D
Hendrickx
Koen
K
Rijckaert
Dirk
D
Thibo
Patrick
P
Van Biervliet
Philippe
P
Blot
Stijn I
SI
Colardyn
Francis
F
D000208:Acute Disease; D000309:Adrenal Insufficiency / Q000150:complications / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D010195:Pancreatitis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index
D006854:Hydrocortisone