title: Adrenocorticotropic hormone but not high-density lipoprotein cholesterol or salivary cortisol was a predictor of adrenal insufficiency in patients with septic shock.
abstract: Relative adrenal insufficiency in sepsis has been extensively debated on; however, accurate diagnosis and therapeutic intervention remain controversial. The authors aimed to evaluate adrenocorticotropic hormone (ACTH), salivary cortisol, total cortisol and estimated plasma-free cortisol, cholesterol, and lipoproteins as predictors of adrenal insufficiency in patients within 24 h of septic shock diagnosis. This prospective study evaluated all hospitalized patients older than 18 years who developed septic shock and were using vasoactive drugs within 24 h of diagnosis. Blood and saliva samples were drawn at baseline and 60 min (T60) after 250 μg tetracosactide intravenous injection. Patients were divided into two groups: responders (Δ [T60 minus baseline] total cortisol >9 μg/dL) and nonresponders (Δ total cortisol ≤ 9 μg/dL or baseline total cortisol <10 μg/dL). The latter group was considered to have adrenal insufficiency. A total of 7,324 hospitalized patients were monitored, and 34 subjects with septic shock were included in the analysis. Adrenal insufficiency was found in 32.4%. Total cholesterol, high-density lipoprotein cholesterol, triglycerides, and salivary cortisol did not differ between groups. Estimated plasma-free cortisol was not better than total plasma cortisol in estimating adrenal function. Baseline endogenous ACTH was higher in nonresponders than responders (55.5 pg/mL vs. 18.3 pg/mL, respectively; P = 0.01). The cutoff ACTH value that discriminated patients with adrenal insufficiency was 31.5 pg/mL. Thus, endogenous ACTH measured within 24 h of septic shock diagnosis could predict adrenal response to tetracosactide.
authors.affiliation: *Postgraduate Program in Health Sciences, and; †Division of Intensive Care, Department of Internal Medicine, Londrina State University, Londrina-PR; ‡Department of Earth Science, Federal University of Paraná, Curitiba-PR; §Laboratory of Hormones and Molecular Genetics (LIM-42), Division of Endocrinology, School of Medicine, University of São Paulo, São Paulo-SP; and ∥Division of Endocrinology, Department of Internal Medicine, Londrina State University, Londrina-PR, Brazil.
authors.forename: Josiane
authors.initials: J
authors.lastname: Festti
authors.forename: Cintia Magalhães Carvalho
authors.initials: CM
authors.lastname: Grion
authors.forename: Luciana
authors.initials: L
authors.lastname: Festti
authors.forename: Tânia Longo
authors.initials: TL
authors.lastname: Mazzuco
authors.forename: Helena Pantelion
authors.initials: HP
authors.lastname: Lima-Valassi
authors.forename: Vinícius Nahime
authors.initials: VN
authors.lastname: Brito
authors.forename: Décio Sabbatini
authors.initials: DS
authors.lastname: Barbosa
authors.forename: Alexandre José Faria
authors.initials: AJ
authors.lastname: Carrilho
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D005260:Female; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry; D012772:Shock, Septic / Q000150:complications*
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D000324:Adrenocorticotropic Hormone; D002784:Cholesterol; D006854:Hydrocortisone