Document Detail


Relative adrenal insufficiency in patients with severe acute pancreatitis.
MedLine Citation:
PMID:  17572872     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with RAI and to describe how adrenal responsiveness affects outcome. DESIGN: Prospective observational multicenter study. PATIENTS: Twenty-five patients with severe acute pancreatitis. INTERVENTIONS: A short Synacthen test (SST) was performed within 5 days after admission to the hospital. The incidence of RAI, defined as an increment after SST of less than 9 microg/dl was the primary endpoint of the study. Serum cortisol was measured at baseline and at 30 and 60 min after administration of 250 microg adrenocorticotropic hormone. MEASUREMENTS AND RESULTS: Median baseline cortisol level was 26.6 microg/dl, and increased to 43.2 microg/dl and 48.8 microg/dl after 30 min and 60 min respectively. RAI was found in 16% of all patients and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from days 4 to 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Twenty-eight-day mortality was significantly higher in patients with RAI (75% vs. 5%, p =0.007). Patients who died had a lower increment in cortisol levels after the SST than patients who survived. CONCLUSION: RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with increased mortality.
Authors:
Jan J De Waele; Eric A J Hoste; Didier Baert; Koen Hendrickx; Dirk Rijckaert; Patrick Thibo; Philippe Van Biervliet; Stijn I Blot; Francis Colardyn
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-06-16
Journal Detail:
Title:  Intensive care medicine     Volume:  33     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-21     Completed Date:  2008-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1754-60     Citation Subset:  IM    
Affiliation:
Intensive Care Unit 1K12-C, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. jan.dewaele@UGent.be
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adrenal Insufficiency / complications,  epidemiology*
Adult
Aged
Bacterial Infections / complications,  mortality
Female
Humans
Hydrocortisone / blood
Male
Middle Aged
Multiple Organ Failure / etiology,  mortality,  physiopathology
Pancreatitis / complications,  mortality,  physiopathology*
Pancreatitis, Acute Necrotizing / complications,  mortality,  physiopathology
Prospective Studies
Severity of Illness Index
Chemical
Reg. No./Substance:
50-23-7/Hydrocortisone

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


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