PURPOSE: Adrenal insufficiency has been recently recognized as complicating septic shock. The prevalence of adrenal insufficiency amongst patients with severe sepsis and shock is unknown. We prospectively studied the prevalence of adrenal insufficiency in elderly patients with septic shock.
METHODS: All patients over the age of seventy admitted to the medical intensive care unit (MICU) with a diagnosis of septic shock between July 1, 2004 and December 31, 2005 were studied. A random cortisol level was obtained upon admission to the MICU. An ACTH stimulation test using 250 μg dose of cosyntropin was performed and a cortisol sample was repeated sixty minutes later. All patients required vasopressor support. Patients who received propofol, etomidate, or exogenous steroids within three months, were excluded.
RESULTS: One hundred ninety six patients were enrolled in the study. The mean age was 79.4 (±10.4). The mean random cortisol level was 13.8 (± 5.1). The average response to cosyntropin was 6.3 (± 1.7). Overall, 183 patients (93%) demonstrated adrenal insufficiency. Serum Na levels averaged 137 (± 8), average K was 4.3 (± 1.6), average glucose was 154 (± 28). Eosinophilia was not noted.
CONCLUSION: Adrenal insufficiency is common in elderly patients with septic shock. Laboratory findings typically seen in adrenal insufficiency were not seen in most patients.
CLINICAL IMPLICATIONS: Adrenal insufficiency is a common condition in elderly patients with septic shock. Empiric treatment with corticosteroids in “stress doses” may be clinically beneficial.
DISCLOSURE: Alex Morizio, None.