Acute Adrenal Insufficiency presenting as Shock After Trauma and Surgery

Claussen, Mark S.; Landercasper, Jeffrey; Cogbill, Thomas H.

doi:10.1097/00005373-199201000-00020

Cited by 61 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 Another complicating factor is the occurrence of an acute adrenal crisis within the population of head-injured patients, which may result from bilateral adrenal hemorrhage. 18 In a study conducted by Atchinson and colleagues, 9 in a group of patients with TBI absolute hyponatremia but no adrenal insufficiency was associated with cognitive impairments that were very similar to those symptoms frequently seen in primary adrenal insufficiency. 71 The development of acute adrenal crisis after adrenal infarction or hemorrhage may lead to fulminant shock and death, if not recognized and acted on quickly.…”

Section: Neurosurg Focus / Volume 16 / April 2004mentioning

confidence: 90%

Hyponatremia in the neurosurgical patient: diagnosis and management

Cole¹,

Gottfried²,

Liu³

et al. 2004

FOC

View full text Add to dashboard Cite

Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

show abstract

Section: Neurosurg Focus / Volume 16 / April 2004mentioning

confidence: 90%

Hyponatremia in the neurosurgical patient: diagnosis and management

Cole¹,

Gottfried²,

Liu³

et al. 2004

FOC

View full text Add to dashboard Cite

show abstract

“…They include hypovolemic shock (decreased preload, depressed myocardial contractility, and increased systemic vascular resistance) 19,20 and hyperdynamic shock (high cardiac output and decreased systemic vascular resistance similar to those in septic shock). [20][21][22][23][24] These different hemodynamic findings may reflect the fact that some patients had already received some volume replacement before cardiovascular function was studied or that their mineralocorticoid secretion varied depending on whether they had primary or secondary adrenal insufficiency. One important conclusion is that hypotension in patients with adrenal insufficiency may mimic either hypovolemic or septic shock, a conclusion that emphasizes the need to include adrenal insufficiency in the differential diagnosis of both.…”

Section: Effect Of Corticosteroids On Circulatory Aspects Of the Strementioning

confidence: 99%

Corticosteroid Therapy in Severe Illness

1997

View full text Add to dashboard Cite

“…27 Besides hypotension and decreased cardiac output, some patients with AI may present with a septic appearance (high-output circulatory failure, fever, and mental status changes), although they are abacteremic. 3,7,15,18 Adding further complexity is the absence of laboratory abnormalities and physical findings that are characteristic of adrenal failure (i.e., hyponatremia, hyperkalemia, and cutaneous hyperpigmentation) in the early course of these critically ill patients. 3,5,7,15,28 There is therefore a need for early recognition of hypotensive patients who may be experiencing AI, as it is relatively easy to diagnose and treat while a potential cause of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…However, in critically ill patients, adrenal dysfunction has been defined as the presence of random serum cortisol <20 g/dL (<552 nmol/L). [16][17][18][19][20][21] An additional category, functional hypoadrenalism (FH), has been defined as the combination of random serum cortisol Ն20 g/dL, and a serum cortisol level at 60 minutes post-ACTH stimulation of <30 g/ dL or delta cortisol (60-minute level minus baseline) of Յ9 g/dL.…”

Section: Methodsmentioning

confidence: 99%

Adrenal Dysfunction in Hemodynamically Unstable Patients in the Emergency Department

Rivers

Blake

Dereczyk

et al. 1999

Academic Emergency Medicine

View full text Add to dashboard Cite

Abstract. Objective: Adrenal failure, a treatable condition, can have catastrophic consequences if unrecognized in critically ill ED patients. The authors' objective was to prospectively study adrenal function in a case series of hemodynamically unstable (highrisk) patients from a large, urban ED over a 12-month period. Methods: In a prospective manner, critically ill adult patients presenting to the ED were enrolled when presenting with a mean arterial blood pressure Յ60 mm Hg requiring vasopressor therapy for more than one hour after receiving fluid resuscitation (central venous pressure of 12-15 mm Hg or a minimum of 40 mL/kg of crystalloid). Patients were excluded if presenting with hemorrhage, trauma, or AIDS, or if steroids were used within the previous six months. An adrenocorticotropic hormone (ACTH) stimulation test was performed and serum cortisol was measured. Treatment for adrenal insufficiency was not instituted. Results: A total of 57 consecutive patients were studied. Of these, eight (14%) had baseline serum cortisol concentrations of <20 g/dL (<552 nmol/L), which was considered adrenal insufficiency (AI). Three additional patients (5%) had subnormal 60-minute post-ACTH-stimulation cortisol responses (<30 g/dL) and a delta cortisol Յ9 g/dL, which is the difference between the baseline and 60-minute levels. This is functional hypoadrenalism (FH). There were no laboratory abnormalities that distinguished patients with AI or FH from those with preserved adrenal function (PAF). Rates of survival to discharge did not differ between the AI group (7 of 8) and PAF patients (21 of 46; p = 0.052). Conclusions: Adrenal dysfunction is common in high-risk ED patients. Overall, it has a frequency of 19% among a homogeneous population of hemodynamically unstable vasopressor-dependent patients. The effect of physiologic glucocorticoid replacement in this setting remains to be determined. Key words: adrenal insufficiency; adrenal dysfunction; hypotension; shock; emergency; functional hypoadrenalism; adrenal crisis; hypoadrenalism. ACADEMIC EMERGENCY MEDICINE 1999; 6:626-630 C ORTISOL is a major stress response hormone that has metabolic, catabolic, anti-inflammatory, and vasoactive properties on cardiac muscle and the peripheral vasculature. Cortisol mediates maintenance of peripheral vasomotor tone by facilitating catecholamine-induced vasoconstriction and it has a permissive effect on synthesis of catecholamines and vasoactive peptides.

show abstract

Acute Adrenal Insufficiency presenting as Shock After Trauma and Surgery

Cited by 61 publications

References 0 publications

Hyponatremia in the neurosurgical patient: diagnosis and management

Hyponatremia in the neurosurgical patient: diagnosis and management

Corticosteroid Therapy in Severe Illness

Adrenal Dysfunction in Hemodynamically Unstable Patients in the Emergency Department

Contact Info

Product

Resources

About