Adrenocortical function and multiple organ failure in severe sepsis

Loisa, Pekka; Rinne, Timo; Kaukinen, S.

doi:10.1034/j.1399-6576.2002.460204.x

Cited by 45 publications

(41 citation statements)

References 43 publications

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“…Estimates of the prevalence of adrenal dysfunction among critically ill patients vary widely, from 0.66 to over 40%, depending on the definition of adrenal dysfunction and the specific patient population studied (3,6,9,25,35,36,40). Drugs administered to such patients may contribute to adrenal dysfunction by increasing the rate at which cortisol is metabolized (20) or, as in the case of etomidate (8,46) or ketoconazole (26,30,33,34), by inhibiting enzymes in the steroid biosynthetic pathway.…”

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confidence: 99%

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Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Magill

Puthanakit²,

Carson

et al. 2004

Antimicrob Agents Chemother

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Fluconazole is widely used in the intensive care unit for prevention and treatment of fungal infections. Case reports have described an association between fluconazole and adrenal dysfunction, an important cause of morbidity and mortality in critically ill patients. We sought to determine whether 400 mg of fluconazole per day administered to critically ill surgical patients was associated with a reduction in cortisol levels. Cortisol levels were measured in stored plasma specimens drawn from 154 critically ill surgical patients randomized in 1998-1999 to receive fluconazole or placebo for the prevention of candidiasis. The primary outcome measure was the median plasma cortisol level >1 day after study drug initiation (MPCL). Secondary outcomes were adrenal dysfunction, defined as an MPCL of <15 g/dl, changes in cortisol levels over time, and mortality. The median MPCL was 15.75 g/dl (interquartile range [IQR], 11.65 to 21.33 g/dl) in 79 patients randomized to fluconazole and 16.71 g/dl (IQR, 11.67 to 23.00 g/dl) in 75 patients randomized to placebo (P ‫؍‬ 0.52). Patients randomized to fluconazole did not have significantly increased odds of adrenal dysfunction compared to patients randomized to placebo (odds ratio, 0.98; 95% confidence interval, 0.48 to 2.01). Randomization to fluconazole was not associated with a significant difference in cortisol level changes over time. Mortality was not different between patients with and without adrenal dysfunction, nor was it different between patients with adrenal dysfunction who were randomized to fluconazole and those randomized to placebo. Fluconazole prophylaxis in this population of critically ill surgical patients did not result in significant adrenal dysfunction.

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confidence: 99%

“…Adrenal dysfunction is an important cause of morbidity and mortality in critically ill patients (20,25,35,40). Estimates of the prevalence of adrenal dysfunction among critically ill patients vary widely, from 0.66 to over 40%, depending on the definition of adrenal dysfunction and the specific patient population studied (3,6,9,25,35,36,40).…”

mentioning

confidence: 99%

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Magill

Puthanakit²,

Carson

et al. 2004

Antimicrob Agents Chemother

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“…По данным литературы, у 54% пациентов заболевание впервые диагности-руют, когда пациент находится в критическом состоянии [5]. В таких случаях летальность со-ставляет 40-50% [7,8].…”

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Difficulties in diagnosis of addisonian crisis in primary adrenal insufficiency

et al. 2016

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The observation of a rare case of Addisonian crisis, which developed in 28-year old patient with asymptomatic hypocorticoidism in a stressful situation and was fatal, is described. In patient with left-sided interrupted tubal pregnancy after recovery from anesthesia after a successful laparoscopic tubectomy, shock blood pressure lowering happened, an acute left ventricular heart failure occurred. Addisonian crisis developed under stress conditions (pregnancy, rupture of the fallopian tube, culdocentesis, anesthesia, performed surgery) amid the previously undiagnosed primary adrenal insufficiency due to congenital hypoplasia of the adrenal cortex. During the autopsy there was found hypoplasia of fasciculate and reticular zones of adrenal cortex, which formed only about 40%, while normally form 85% of the adrenal cortex. Under stress (in the presence of normal adrenal glands) fasciculate zone must significantly increase in size (and account for more than 75%), while in patient who was under the severe stress they accounted for only 10-20% of the adrenal cortex. Adrenal insufficiency was not recognized. The patient has no hyperpigmentation and hyperkalemia, which confirms the conclusion of primary adrenal insufficiency. Therapeutic measures were reduced to the administration of low-dose prednisone, sympathomimetic drugs and liquid. Due to the possible existence of forms of the adrenal insufficiency with mild manifestations, there should be an awareness in terms of possible hypocorticoidism in case of development of hemodynamic instability in response to stress, despite intensive infusion therapy and administration of adrenergic drugs. In such cases, it is necessary to administer, perhaps ex juvantibus, high doses of glucocorticoids, which at the correct diagnosis match «as the key to the lock», and at the same time are safe for use. In the treatment of shock of various etiologies, there is a need for wider use of glucocorticoid therapy using high doses of hormones.

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“…1 Akhir-akhir ini insufisiensi adrenal dilaporkan cukup sering pada pasien kritis seperti sepsis berat dan syok septik dengan insidens 15%-61%. [4][5][6][7][8][9][10][11][12][13][14][15][16] Kondisi tersebut bersifat sementara dan akan kembali normal dengan membaiknya sepsis sehingga diduga mediator inflamasi yang dilepaskan selama syok septik menyebabkan disfungsi jaras HHA dan insufisiensi adrenal. 17,18 Hingga saat ini belum ada kesepakatan mengenai kadar kortisol yang dianggap adekuat sebagai respons terhadap stres, selain itu penelitian pada populasi pediatrikpun masih terbatas.…”

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“…17,18 Hingga saat ini belum ada kesepakatan mengenai kadar kortisol yang dianggap adekuat sebagai respons terhadap stres, selain itu penelitian pada populasi pediatrikpun masih terbatas. Berbagai penelitian [4][5][6][7][8][9][10][11][12][13][14][15][16] melaporkan adanya hubungan kuat antara insufisiensi adrenal dengan syok refrakter katekolamin sehingga diduga insufisiensi adrenal merupakan salah satu penyebab masih tingginya mortalitas pada sepsis. Penelitian bertujuan mengetahui profil fungsi adrenal pada anak sepsis sebagai salah satu upaya menurunkan morbiditas dan mortalitas akibat sepsis.…”

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Fungsi Adrenal pada Sepsis di Unit Perawatan Intensif Pediatrik

Rachmawati¹,

Widodo²,

Aap³

et al. 2016

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Latar belakang. Insufisiensi adrenal sering dijumpai pada pasien syok septik dan berhubungan dengankejadian syok refrakter katekolamin dan peningkatan mortalitas.Tujuan. Mengetahui profil fungsi adrenal pada anak yang menderita sepsis di Unit Perawatan IntensifPediatrik RSCM.Metode. Penelitian deskriptif dengan desain potong lintang. Semua subjek menjalani uji stimulasikortikotropin dosis standar. Insufisiensi adrenal (IA) ditegakkan jika respons peningkatan kortisol terhadapuji (􀀧 maks) 􀁤9 μg/dl dan dikelompokkan menjadi absolut (IAA) jika kortisol pra-uji t0 <20 μg/dl danrelatif (IAR) jika t0 􀁴20 μg/dl.Hasil. Tiga puluh anak sepsis (18 laki-laki) diikutsertakan dalam penelitian. usia median adalah 29 (1-153)bulan dan median skor PELOD 12,5 (0-33). Insufisiensi adrenal dijumpai pada 8 (26,7%) pasien (2 IAA and6 IAR), lebih sering pada perempuan (p=0,003), serta cenderung lebih sering pada syok septik (p=0,682).Median t0 32,75 (4,23-378) μg/dl, t30-60 48,20 (16,70-387) μg/dl, dan 􀀧 maks 15,40 (0,90-60,80) μg/dl. Kadar t0 dan t30-60 lebih tinggi pada kelompok syok septik (p=0,03 dan p=0,01) namun tidak berbedaantara subjek dengan dan tanpa IA. Terdapat kecenderungan korelasi positif antara skor PELOD dengant0 dan t30-60 (r=0,7; dan r=0,6; p􀁤0,001). Hipotensi sistolik dijumpai pada seluruh subjek dengan IA dansyok refrakter katekolamin cenderung lebih sering pada kelompok IA (p=0,67). Mortalitas 36,7%, tidakberbeda antara subjek dengan dan tanpa IA.Kesimpulan. Insufisiensi adrenal sering dijumpai pada yang menderita anak sepsis dan harus dipertimbangkanpada kondisi syok septik. Penelitian lanjutan diperlukan untuk menentukan efektivitas terapi steroid.

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Adrenocortical function and multiple organ failure in severe sepsis

Cited by 45 publications

References 43 publications

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Difficulties in diagnosis of addisonian crisis in primary adrenal insufficiency

Fungsi Adrenal pada Sepsis di Unit Perawatan Intensif Pediatrik

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