Adrenal insufficiency in severe West Nile Virus infection
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To explore adrenal function in severe West Nile virus (WNV) infection.
Design and setting
Prospective interventional cohort study in a medical ICU of a teaching hospital.
Ten consecutive patients (seven men, mean age 64 ± 12 years, mean SAPS II 26 ± 6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39 ± 1°C) and altered mental status (mean Glasgow Coma Score 11 ± 2). Mean SOFA score was 9 ± 2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation.
A short corticotropin test was performed in each patient to assess the adrenal function.
Measurements and results
Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 μg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 μg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 μg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived.
Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.
- Gea-Banacloche J, Johnson RT, Bagic A, Butman JA, Murray PR, Agrawal AG (2004) West Nile virus: pathogenesis and therapeutic options. Ann Intern Med 140:545–653
- Carlson RH (2001) West Nile virus in the USA—an update. Lancet Infect Dis 1:143 CrossRef
- Granwehr BP, Lillibridge KM, Higgs S, Mason PW, Aronson JF, Campbell GA, Barrett ADT (2004) West Nile virus: where are we now? Lancet Infect Dis 4:547–556 CrossRef
- Hayes EB (2005) Virology, pathology, and clinical manifestations of West Nile virus disease. Emerg Infect Dis 11:1174–1179
- Annane D, Bellissant E, Cavaillon JM (2005) Septic shock. Lancet 365:63–78 CrossRef
- Annane D, Briegel J, Sprung CL (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:2157–2159 CrossRef
- Annane D, Bellissant E (2000) Prognostic value of cortisol response in septic shock. JAMA 284:308–309 CrossRef
- Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871 CrossRef
- Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y (2004) Corticosteroids for treating severe sepsis and septic shock. Cochrane Database Syst Rev (1):CD002243
- Malerba G, Romano-Girard F, Cravoisy A, Dousset B, Nace L, Levy B, Bollaert PE (2005) Risk factors of relative adrenocortical deficiency in intensive care patients needing mechanical ventilation. Intensive Care Med 31:388–392 CrossRef
- Cooper MS, Stewart PM (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:727–7234 CrossRef
- Ho JT, Al-Musalhi H, Chapman MJ, Quach T, Thomas PD, Bagley CJ, Lewis JG, Torpy DJ (2006) Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab 91:105–114 CrossRef
- Dickstein G (2005) On the term “relative adrenal insufficiency”—or what do we really measure with adrenal stimulation tests? J Clin Endocrinol Metab 90:4973–4974 CrossRef
- Widmer IE, Puder JJ, Konig C, Pargger H, Zerkowski HR, Girard J, Muller B (2005) Cortisol response in relation to the severity of stress and illness. J Clin Endocrinol Metab 90:4579–4586 CrossRef
- Hamrahian AH, Oseni TS, Arafah BM (2004) Measurements of serum free cortisol in critically ill patients. N Engl J Med 350:1629–1638 CrossRef
- Quirk M (2002) First treatment trial for West Nile infection begins. Lancet Infect Dis 2:589 CrossRef
- Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y (2004) Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ 329:480 CrossRef
- Pyrgos V, Younus F (2004) High-dose steroids in the management of acute flaccid paralysis due to West Nile virus infection. Scand J Infect Dis 36:509–512 CrossRef
- Maxime V, Fitting C, Annane D, Cavaillon JM (2005) Corticoids normalize leukocyte production of macrophage migration inhibitory factor in septic shock. J Infect Dis 191:138–144 CrossRef
- Freda PU, Bilezikian JP (1999) The hypothalamus-pituitary-adrenal axis in HIV disease. AIDS Read 9:43–50
- Hoshino Y, Yamashita N, Nakamura T, Iwamoto A (2002) Prospective examination of adrenocortical function in advanced AIDS patients. Endocr J 49:641–647 CrossRef
- Seel K, Guschmann M, van Landeghem F, Grosch-Worner I (2000) Addison-disease-an unusual clinical manifestation of CMV-end organ disease in pediatric AIDS. Eur J Med Res 5:247–250
- Takasawa A, Morimoto I, Wake A, Haratake J, Fujii K, Okada Y, Oda S, Hashimoto H, Eto S (1995) Autopsy findings of Addison's disease caused by systemic cytomegalovirus infection in a patient with acquired immunodeficiency syndrome. Intern Med 34:533–536
- Adrenal insufficiency in severe West Nile Virus infection
Intensive Care Medicine
Volume 32, Issue 10 , pp 1636-1639
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