Plasma cortisol levels before and during "low-dose" hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock

Oppert, Michael; Reinicke, Albrecht; Gräf, K.-J.; Barckow, D.; Frei, Ulrich; Eckardt, Kai‐Uwe

doi:10.1007/s001340000685

Cited by 98 publications

(83 citation statements)

References 22 publications

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“…37 Because gastroenteritis is a frequent precipitant (or presentation) of an adrenal crisis, [15][16][17][18] and an increase in oral glucocorticoids does not always avert an adrenal crisis, 18,38 there should be a low threshold for early parenteral hydrocortisone administration to ensure adequate systemic absorption in patients who cannot tolerate oral medications or fail to respond to stress doses. Physicians should also consider giving additional doses in severe emotional stress (eg, bereavement) if required.…”

Section: Prevention Of Adrenal Crisis Glucocorticoid Stress Doses Andmentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

134

140

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Adrenal crisis is a life-threatening medical emergency, associated with a high mortality unless it is appropriately recognized and early treatment is rendered. Despite it being a treatable condition for almost 70 years, failure of adequate preventive measures or delayed treatment has often led to unnecessary deaths. Gastrointestinal illness is the most common precipitant for an adrenal crisis. Although most patients are educated about "sick day rules," patients, and physicians too, are often reluctant to increase their glucocorticoid doses or switch to parenteral injections, and thereby fail to avert the rapid deterioration of the patients' condition. Therefore, more can be done to prevent an adrenal crisis, as well as to ensure that adequate acute medical care is instituted after a crisis has occurred. There is generally a paucity of studies on adrenal crisis. Hence, we will review the current literature, while also focusing on the incidence, presentation, treatment, prevention strategies, and latest recommendations in terms of steroid dosing in stress situations.

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Section: Prevention Of Adrenal Crisis Glucocorticoid Stress Doses Andmentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

134

140

View full text Add to dashboard Cite

show abstract

“…By doubling this value, a high safety margin concerning sufficient glucocorticoid availability can be assumed. Furthermore, patients in intensive care with such cortisol concentrations are considered sufficiently protected from cortisol deficiency, and in general, the average serum cortisol concentration remains below these concentrations in patients with critical illness (3,12,13,14,16). With a mean time of 22 min (95% CI 15-29 min) to reach this target concentration, s.c. administration of hydrocortisone, therefore, clearly fulfills the requirements for rapidly covering the increased glucocorticoid needs in case of emergency.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency

Hahner

Burger-Stritt

Allolio

2013

European Journal of Endocrinology

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Objective: Evaluation of the pharmacokinetics and safety of s.c. hydrocortisone injection for use in adrenal emergency. Design: Single-center, open-label, sequence-randomized, crossover study in a tertiary care center. Patients and methods: Twelve patients with chronic Addison's disease. Comparison of hydrocortisone pharmacokinetics after s.c. and i.m. injection (100 mg) and after s.c. administration of sodium chloride (0.9%) respectively at three different visits. Main outcome measure: maximum serum cortisol (C max ), time to C max (t max ), and time to serum cortisol O36 mg/dl (t serum cortisol O36 mg/dl ) after s.c. administration compared with i.m. administration, safety, and patient preference. Results: Serum cortisol increased rapidly and substantially after both i.m. and s.c. injections (C max : 110G29 vs 97G28 mg/dl, PZ0.27, t max : 66G51 vs 91G34 min, PZ0.17, and t serum cortisol O 36 mg/dl : 11G5 vs 22G11 min, PZ0.004 respectively). Both i.m. and s.c. injections were well tolerated. Eleven (91.7%) patients preferred s.c. injection, whereas one patient did not have any preference. Conclusions: S.c. administration of 100 mg hydrocortisone shows excellent pharmacokinetics for emergency use with only a short delay in cortisol increase compared with i.m. injection. It has a good safety profile and is preferred by patients over i.m. injection.

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“…The algorithm described by Coolens et al (17) applied in other studies (10,12) takes into account the binding characteristics of CBG and is applicable by use of standard spreadsheet software; this calculation, however, is simplified in that the concentration of albumin and sexhormone-binding globulin (as other important cortisol-binding proteins), and competing steroids as cortisone are not incorporated. Conclusive calculation of free serum cortisol concentrations taking into account the latter variables, however, is not generally applicable, since it leads to complex equations which have to be solved by numeric procedures for which no software is commercially available (11,19,22).…”

Section: Discussionmentioning

confidence: 99%

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

Vogeser¹,

Groetzner²,

Küpper³

et al. 2003

Clinical Chemistry and Laboratory Medicine

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In severely ill patients low concentrations of the corticosteroid binding globulin are typically found; the aim of this study was to quantify directly free bioactive cortisol concentrations in the sera of postoperative cardiosurgical patients. Serum samples of 12 consecutive patients undergoing aortocoronary bypass surgery taken preoperatively and on the postoperative days 1 to 4 were analyzed. Total serum cortisol was quantified using liquid chromatography-tandem mass spectrometry with an on-line sample extraction system and tri-deuterated cortisol as the internal standard, and free serum cortisol was measured after over-night equilibrium dialysis. Whereas on the first postoperative day, the median total serum cortisol concentration was approximately two-fold increased compared to preoperative samples (preoperatively, 245 nmol/l (interquartile range (IQR) 203 -293 nmol/l); first postoperative day, 512 nmol/l (IQR 410 -611 nmol/l)), median dialyzable free cortisol concentration was almost seven-fold increased (preoperatively, 14.2 nmol/l (IQR 10.9 -20.7 nmol/l); first postoperative day, 98.3 nmol/l (IQR 81.3 -134 nmol/l)). On the fourth postoperative day, median free cortisol was still significantly increased compared to baseline sampling (p < 0.05), whereas median total cortisol was not. A median of 5.7% (IQR 5.4 -7.0%) of total cortisol was found as free cortisol on the preoperative day, 21.2% (IQR 18.9 -23.5%) on the first postoperative day and 10.5% (IQR 9.8 -14.0%) on the fourth postoperative day. It is concluded that during the postoperative period the freeto-bound ratio of cortisol is highly variable and that during the acute phase response direct quantification of free bioactive cortisol concentrations seems to be biologically more appropriate than the measurement of total cortisol concentrations. Clin Chem Lab Med 2003; 41(2):146 -151

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Plasma cortisol levels before and during "low-dose" hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock

Cited by 98 publications

References 22 publications

Adrenal Crisis: Still a Deadly Event in the 21st Century

Adrenal Crisis: Still a Deadly Event in the 21st Century

Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

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