Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

Relative adrenal insufficiency in patients with severe acute pancreatitis.

De Waele JJ, Hoste EA, Baert D, Hendrickx K, Rijckaert D, Thibo P, Van Biervliet P, Blot SI, Colardyn F

Intensive Care Unit 1K12-C, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium, jan.dewaele@UGent.be.

OBJECTIVE: Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with RAI and to describe how adrenal responsiveness affects outcome. DESIGN: Prospective observational multicenter study. PATIENTS: Twenty-five patients with severe acute pancreatitis. INTERVENTIONS: A short Synacthen test (SST) was performed within 5 days after admission to the hospital. The incidence of RAI, defined as an increment after SST of less than 9[Symbol: see text]mug/dl was the primary endpoint of the study. Serum cortisol was measured at baseline and at 30 and 60[Symbol: see text]min after administration of 250[Symbol: see text]mug adrenocorticotropic hormone. MEASUREMENTS AND RESULTS: Median baseline cortisol level was 26.6[Symbol: see text]mug/dl, and increased to 43.2[Symbol: see text]mug/dl and 48.8[Symbol: see text]mug/dl after 30[Symbol: see text]min and 60[Symbol: see text]min respectively. RAI was found in 16% of all patients and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from days 4 to 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Twenty-eight-day mortality was significantly higher in patients with RAI (75% vs. 5%, p[Symbol: see text]=[Symbol: see text]0.007). Patients who died had a lower increment in cortisol levels after the SST than patients who survived. CONCLUSION: RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with increased mortality.

Published 21 September 2007 in Intensive Care Med, 33(10): 1754-60.
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