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Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock

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Abstract

Objective

To characterise the plasma cortisol profile and adreno-cortial responsiveness (short Synacthen test) of patients in septic shock.

Design

Retrospective assessment using case-notes and ICU charts.

Setting

University teaching hospital ICU.

Patients

68 septic shock patients with plasma cortisol and/or short Synacthen test measured at ICU-admission or onset of shock post ICU-admission. Patients were identified from a total population of 155 patients who had PCL and/or SST measured over a 4.5 year period.

Intervention

None.

Measurements and results

Patients with septic shock had a plasma cortisol ranging from 210–8900 nmol/l and mortality of 56%. There were 22 (32%) below (low) and 46 (68%) above (high) a ‘critical’ plasma cortisol of 500 nmol/l. Using stepwise logistic regression, mortality was adequately predicted by and increased with, increasing plasma cortisol and onset of shock remote from ICU-admission. Short Synacthen tests were available in 33 patients: 11 responders (cortisol increment >200 nmol/l above baseline 30 min after 0.25 mg intravenous Synacthen) and 22 hypo-responders. Mortality in patients was adequately predicted by and increased with a decrease in cortisol increment post-Synacthen. Thirteen patients (plasma cortisol 606±[SD] 297 nmol/l) had complete haemodynamic profiles before inotropic therapy; no relationship was demonstrated between plasma cortisol and circulatory variables. Follow-up revealed no cases of Addison's disease.

Conclusions

In septic shock, ‘hypocortisolaemia’ is not uncommon and does not predict a high mortality; adrenocortical hypo-responsiveness may be associated with poor outcome.

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Authors and Affiliations

  1. Intensive Care Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia

    J. L. Moran, M. J. Chapman, M. S. O'Fathartaigh & A. R. Peisach

  2. Department of Clinical Chemistry, The Queen Elizabeth, Hospital, Woodville, South Australia, Australia

    P. R. Pannall

  3. Department of Statistics, University of Adelaide, Woodville Road, 5011, Adelaide, South Australia, Australia

    P. Leppard

Authors
  1. J. L. Moran
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  2. M. J. Chapman
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  3. M. S. O'Fathartaigh
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  4. A. R. Peisach
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  5. P. R. Pannall
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  6. P. Leppard
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Moran, J.L., Chapman, M.J., O'Fathartaigh, M.S. et al. Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock. Intensive Care Med 20, 489–495 (1994). https://doi.org/10.1007/BF01711901

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  • DOI: https://doi.org/10.1007/BF01711901

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