title: Adrenal insufficiency in cardiothoracic patients: an evaluation of the corticotrophin stimulation test and other diagnostic methods.
abstract: OBJECTIVE
  The purposes of the study were to determine the incidence of adrenal insufficiency (AI) using several published techniques, compare the response rates using a low-dose (LD) corticotropin (ACTH) stimulation test vs a standard dose (SD), and identify the technique that is most closely related to vasopressor use.
  
  
  METHODS
  Consecutive adult patients who were undergoing open heart surgery for CAD or valvular disease were prospectively enrolled. Exclusion criteria included history of steroid use, operative steroid, or etomidate administration. Postoperatively, each patient underwent ACTH stimulation with 1 μg (LD) and 249 μg (SD), 60 minutes apart. Agreement among the tests was evaluated, and vasopressor use was compared between groups.
  
  
  RESULTS
  There were 40 patients evaluated. The incidence of AI based on operative change, postoperative values, and LD-ACTH and SD-ACTH tests was 53%, 38%, 60%, and 38%, respectively. Agreement between the LD- and SD-ACTH tests was 73% (κ = 0.476, P = .001). There was a significant difference in the need for (93% vs 52%, P = .013) and duration (18.9 [0-180.6] vs 0.6 [0-73.2] hours, P = .003) of vasopressor therapy in patients with and without AI but only using the SD-ACTH definition.
  
  
  CONCLUSIONS
  The incidence of AI will vary greatly based on technique used for diagnosis. The SD-ACTH stimulation test should be used to determine AI in open heart patients postoperatively because of the close association with vasopressor usage.
authors.affiliation: Medical University of South Carolina, Department of Trauma and General Surgery, Charleston, SC 29425, USA. evsurgery@gmail.com
authors.forename: Evert A
authors.initials: EA
authors.lastname: Eriksson
authors.forename: Charles L
authors.initials: CL
authors.lastname: Willekes
authors.forename: Karen J
authors.initials: KJ
authors.lastname: McAllen
authors.forename: Oreste M
authors.initials: OM
authors.lastname: Romeo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hooker
authors.forename: James E
authors.initials: JE
authors.lastname: Hoogeboom
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D000324:Adrenocorticotropic Hormone