Document Detail


Adrenal insufficiency in acute coronary syndrome.
MedLine Citation:
PMID:  19907885     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date no known study done to determine its prevalence in patients with ACS. METHODS: 37 patients who fulfilled the diagnostic criteria of ACS were subjected to the low-dose (1 microg) ACTH stimulation test (LDT), followed by a standard-dose (250 microg) ACTH stimulation test (SDT) two hours later. RESULTS: 14 (37.8 percent) patients had ST acute myocardial infarction, eight (21.6 percent) patients had non-ST elevation myocardial infarction, and 15 (40.5 percent) patients had unstable angina. Based on an increment of less than 250 nmol/L post-SDT, no patient had adrenal insufficiency. However, using a similar criteria with the LDT, eight (21.6 percent) patients had adrenal insufficiency. Four patients died during the study and they had very high cortisol levels. The diagnosis of adrenal insufficiency is not associated with any significant morbidity and mortality in our group of patients. CONCLUSION: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality.
Authors:
A W Norasyikin; S Norlela; M Rozita; M Masliza; A S Shamsul; K Nor Azmi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Singapore medical journal     Volume:  50     ISSN:  0037-5675     ISO Abbreviation:  Singapore Med J     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-11-12     Completed Date:  2010-02-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404516     Medline TA:  Singapore Med J     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  962-6     Citation Subset:  IM    
Affiliation:
Department of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia. naw8282kt@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / blood,  complications*
Adrenal Insufficiency / blood,  complications*
Adrenocorticotropic Hormone / metabolism
Adult
Aged
Critical Illness
Female
Humans
Hydrocortisone / metabolism
Hypothalamus / physiology
Male
Middle Aged
Pituitary-Adrenal System / physiology
Time Factors
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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