title: Acute adrenal insufficiency in cervical spinal cord injury.
abstract: BACKGROUND
  Adequate adrenal response is fundamental for the maintenance of physiological homeostasis in the setting of trauma and severe illness. Patients with neurogenic shock are at risk of severe consequences if adrenal insufficiency (AI) is not rapidly identified and treated.
  
  
  OBJECTIVE
  To analyze the incidence of AI in patients with acute cervical spinal cord injury and its effect on in-hospital complications.
  
  
  METHODS
  The medical records of patients older than 18 years who were admitted to the adult neurosurgery service at the University District Hospital as the result of neurogenic shock after acute cervical spinal cord injury from January 2004 to December 2009 were reviewed retrospectively.
  
  
  RESULTS
  One hundred ninety-nine patients were admitted with acute cervical spinal cord injury. A total of 37 patients met the pre-established criteria for neurogenic shock. The incidence of AI in patients with neurogenic shock was 22%. The average random cortisol was 9.3 μg/dL in patients with AI versus 29.2 μg/dL in non-AI. The presence of AI was positively correlated with complications and an increase in the risk of intubation (P = 0.01 and P = 0.002). The 30-day mortality rate in patients with AI was 13% compared with the 3% in the non-AI group (P = 0.39).
  
  
  CONCLUSIONS
  Adrenal insufficiency is a poorly recognized complication in patients with acute cervical spinal cord injury and its aggressive treatment is of utmost importance to avoid further neurological injury.
authors: Department of Surgery, Neurosurgery Section, University of Puerto Rico, San Juan, Puerto Rico. emilapastrana@gmail.com
authors: Emil A
authors: EA
authors: Pastrana
authors: Fanor M
authors: FM
authors: Saavedra
authors: Gisela
authors: G
authors: Murray
authors: Samuel
authors: S
authors: Estronza
authors: John D
authors: JD
authors: Rolston
authors: Gloria
authors: G
authors: Rodriguez-Vega
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012121:Respiration, Artificial; D012306:Risk; D012769:Shock / Q000150:complications; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult
chemical_list: D006854:Hydrocortisone