title: [Relative adrenal insufficiency in septic shock: comparison of the response to hydrocortisone in patients diagnosed through random cortisol measurement versus corticotropin test].
abstract: OBJECTIVE
  The incidence of relative adrenal insufficiency (RAI) in patients with septic shock is high and has a significant impact on survival. The purpose of this study was to determine whether a random cortisol concentration < 25 mg/dL was as good as a low dose (1 mg) corticotrophin stimulation test in the diagnosis of RAI in patients with septic shock as assessed by the hemodynamic response to hydrocortisone.
  
  
  METHODS
  Patients were randomized to a single cortisol determination or to a low dose corticotrophin stimulation test. After blood collection to cortisol determinations, hydrocortisone (100 mg every 8 hrs) was administered for all patients in the first 36 hours. RAI was defined by a random cortisol concentration < 25 mg/dL or a D cortisol concentration < 9 mg/dL in the corticotrophin test.
  
  
  RESULTS
  Sixty patients (G1 = 30; G2 = 30) were included in the analysis and were comparable regarding to demographic data, nosologies and disease severity. The time to norepinephrin withdrawal in group 1 patients with RAI diagnostic criteria was not different from the patients with cortisol > 25 mg/dL. In group 2 patients with D cortisol < 9 mg/dL had a shorter time of norepinephrin infusion (3 days) compared to patients with D cortisol > 9 (6 days).
  
  
  CONCLUSIONS
  This study suggests that 1 mg corticotrophin test is better than a random cortisol determination < 25 mg/dL to the diagnosis of relative adrenal insufficiency in septic shock patients.
authors.affiliation: Associação de Medicina Intensiva Brasileira.
authors.forename: José Raimundo A de
authors.initials: JR
authors.lastname: Azevedo
authors.affiliation: Faculdade de Medicina, Universidade Federal do Maranhão.
authors.forename: Renato Palácio de
authors.initials: RP
authors.lastname: Azevedo
authors.affiliation: Hospital São Domingos.
authors.forename: Rachel Jorge D
authors.initials: RJ
authors.lastname: Cossetti
authors.affiliation: Hospital São Domingos.
authors.forename: Eduardo Rodrigues M
authors.initials: ER
authors.lastname: Lima
authors.affiliation: Hospital São Domingos, São Luis, MA.
authors.forename: Gescirene Borges de
authors.initials: GB
authors.lastname: Sousa