Relative Adrenal Insufficiency Among Trauma Patients in a Community Hospital

Beeman, Brian; Veverka, Thomas J.; Lambert, Peter J.; Boysen, Dennis M.

doi:10.1016/j.cursur.2005.03.020

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…14,21 Recent evidence demonstrates that an "uncoupled" or maladaptive systemic inflammatory response state precipitates development of multisystem organ failure and leads to higher mortality rates. 22,23 Although "classic" AI is rare among trauma patients, occult AI has been noted in up to 60% of severely injured patients.…”

Section: Commentmentioning

confidence: 99%

Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Cotton

Guillamondegui²,

Fleming³

et al. 2008

Arch Surg

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Section: Commentmentioning

confidence: 99%

Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Cotton

Guillamondegui²,

Fleming³

et al. 2008

Arch Surg

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“…Dysfunction of both the hypothalamic-pituitary-adrenal axis and the renin-angiotensinaldosterone system has been noted in septic patients, and a similar pattern of endocrinopathy may be important in trauma [5][6][7][8]. In particular, mineralocorticoid deficiency (MD) presenting as hyperreninemic hypoaldosteronism may contribute to the increased morbidity observed in septic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with MD were significantly more likely to experience hypotension (MAP ≤60 mm Hg) during the study period. MD patients required significantly more units of blood in 48 h than non-MD patients (13 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] versus 5 [2-7], P = 0.015) and had increased crystalloid requirements (18L [14-23] versus 9L [6-10], P < 0.001). MD patients were at higher risk for AKI according to RIFLE and AKIN criteria.…”

Section: Introductionmentioning

confidence: 99%

Mineralocorticoid Deficiency in Hemorrhagic Shock

Tolstoy¹,

Aized²,

McMonagle³

et al. 2012

Journal of Surgical Research

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Background-In the critically ill, mineralocorticoid deficiency (MD) is associated with greater disease severity, the development of acute renal insufficiency, and increased mortality. We hypothesized that severely injured trauma patients presenting with hemorrhagic shock would demonstrate a high degree of MD. We also hypothesized that MD in these patients would be associated with increased length of stay, hypotension, fluid requirements, and acute kidney injury (AKI).Materials and methods-Thirty-two trauma patients in hemorrhagic shock on admission to the trauma bay (SBP <90 mm Hg × 2) were enrolled. Blood samples were obtained on ICU admission and 8, 16, 24, and 48 hours later. Plasma aldosterone (PA) and renin (PR) were assayed by radioimmunoassay. MD was defined as a ratio of PA/PR ≤2. Demographic data, injury severity score, ICU and hospital length of stay, fluid requirements, mean arterial pressure, serum sodium, hypotension, and risk for AKI were compared for patients with and without MD.Results-At ICU admission, 48% of patients met criteria for MD. Patients with MD were significantly more likely to experience hypotension (MAP ≤60 mm Hg) during the study period. MD patients required significantly more units of blood in 48 h than non-MD patients (13 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] versus 5 [2-7], P = 0.015) and had increased crystalloid requirements (18L [14-23] versus 9L [6-10], P < 0.001). MD patients were at higher risk for AKI according to RIFLE and AKIN criteria.Conclusions-MD is a common entity in trauma patients presenting in hemorrhagic shock. Patients with MD required a more aggressive resuscitative effort, were more likely to experience hypotension, and had a higher risk of AKI than non-MD patients. Future studies are needed to fully understand the impact of MD following trauma and the potential role for hormonal replacement therapy.

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“…1 Similarly, among the critically ill within surgical intensive care units (SICU), the frequency of AI is relatively low with estimates approaching 1%; however, among specific subpopulation the frequency is reported to be several fold higher. 2,3 The etiology of AI after acute injury remains to be fully understood. Reports indicate that after thermal injury, AI can be the result of systemic inflammation, sepsis, thrombosis, and coagulopathy with hemorrhagic into the adrenal glands.…”

mentioning

confidence: 99%

Risk Factors Associated With Adrenal Insufficiency in Severely Injured Burn Patients

Reiff

Harkins

McGwin

et al. 2007

Journal of Burn Care & Research

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Acute adrenal insufficiency (AI) is an uncommon disorder among critically ill burn patients, which can often go unrecognized. The goal of the current study is to identify risk factors for AI among patients who have sustained severe thermal injury. A case-control study was conducted among all adult patients admitted to the intensive care unit of the University of Alabama at Birmingham Burn Center during a 7-year period (1997-2003). All burn patients who developed AI were selected as cases (n = 26), and a random sample of those ICU patients who did not develop AI were selected as controls (n = 56). Two variables demonstrated significant independent associations with the risk of AI. Patients who developed AI were older than controls (50 vs. 46 years, respectively) and suffered a significantly greater area of thermal injury when compared with controls (mean percentage of total body surface area burned for cases and controls 45.5% and 25.4%, respectively). Over half (59.1%) of the patients with AI died compared with only 14.6% of controls (P < 0.0001). The development of AI appears to be associated with a greater TBSA burn and older age. After severe thermal injury, the diagnosis of AI substantially increases the risk of death. A better understanding of factors that predispose burn patients to AI may aid in earlier diagnosis, initiation of therapy, and improved outcomes.

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Relative Adrenal Insufficiency Among Trauma Patients in a Community Hospital

Cited by 10 publications

References 21 publications

Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Increased Risk of Adrenal Insufficiency Following Etomidate Exposure in Critically Injured Patients

Mineralocorticoid Deficiency in Hemorrhagic Shock

Risk Factors Associated With Adrenal Insufficiency in Severely Injured Burn Patients

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