title: Acute adrenal insufficiency may affect outcome in the trauma patient.
abstract: Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. The study population included patients receiving a cosyntropin stimulation test (250 microg) and/or random cortisol level based on our practice management guideline and an intensive care unit stay longer than 24 hours. Demographic, acuity, and outcome data were collected. The nonresponders had baseline cortisol levels less than 20 microg/dL or poststimulation rise less than 9 microg/dL. Independent t tests and chi2 statistics were used. One hundred thirty-seven patients had cosyntropin stimulation tests performed. Eighty-two (60%) patients were nonresponders of which 66 were treated with hydrocortisone and 16 went untreated as a result of the discretion of the attending physician. The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: (1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and (2) acute adrenal insufficiency recognized by low random cortisol levels or nonresponse to a stimulation tests should be considered for treatment.
authors.affiliation: Department of Surgery, Division of Trauma, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. oscar.guillamondegui@vanderbilt.edu
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.forename: Shivani
authors.initials: S
authors.lastname: Patel
authors.forename: Sloan
authors.initials: S
authors.lastname: Fleming
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.forename: John A
authors.initials: JA
authors.lastname: Morris
mesh_terms: D000208:Acute Disease; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D003366:Cosyntropin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use*; D007902:Length of Stay; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000401:mortality
chemical_list: D005938:Glucocorticoids; D006728:Hormones; D003366:Cosyntropin; D006854:Hydrocortisone