Acute relative adrenal insufficiency after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
The hypothalamic-pituitary-adrenal axis is an important part of the body's natural response to acute illness. Adrenal insufficiency has the potential to lead to hemodynamic instability and electrolyte imbalances, limit the body's ability to respond to stress, and worsen overall clinical outcome. In this case series, we describe 16 patients evaluated for acute adrenal insufficiency after aneurysmal subarachnoid hemorrhage.


METHODS
Over a 2-year period, the medical records of 16 patients admitted to the adult neurosurgery service for aneurysmal subarachnoid hemorrhage who were nonresponsive to vasopressor therapy and received cosyntropin for the evaluation of adrenal insufficiency within 14 days of their event were reviewed.


METHODS
The median baseline cortisol in this population was 22.5 microg/dL, with a poststimulation cortisol level of 31 microg/dL. Of the population surveyed, a total of 11 patients met the preestablished criteria for adrenal insufficiency, 3 with baseline cortisol levels of less than 15 microg/dL and 11 with poststimulation concentration changes of less than 9 microg/dL. Baseline serum cortisol concentrations were significantly correlated with hospital stay (P = 0.045), intensive care unit stay (P = 0.005), and ventilator days (P = 0.006).


CONCLUSIONS
To date, this is the only investigation evaluating the incidence of acute relative adrenal insufficiency in this population. In our cohort, 69% of the patients met the preestablished criteria for relative adrenal insufficiency. The impact of low-dose corticosteroid therapy in this population also needs review, as it could have significant implications for the management of cerebral vasospasm.
Weant
Kyle A
KA
Department of Pharmacy Practice and Science, Pharmacy Services, University of Kentucky Healthcare, University of Kentucky College of Pharmacy, Lexington, Kentucky 40536, USA. kawean2@email.uky.edu
Sasaki-Adams
Deanna
D
Dziedzic
Kathryn
K
Ewend
Matthew
M
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003366:Cosyntropin / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015994:Incidence; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D003366:Cosyntropin; D006854:Hydrocortisone