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Changes in serum cortisol with age in critically ill patients
Elizabeth Beale1, Jay Zhu, Howard Belzberg
1Division of Trauma and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif 90033, USA. beale@hsc.usc.edu
Gerontology
|February 28, 2002
Summary
Older critically ill patients show a diminished adrenal response to adrenocorticotropin (ACTH) stimulation, despite similar baseline cortisol levels. This age-related impairment in adrenal function warrants further investigation in larger studies.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Geriatrics
Background:
- Mortality in intensive care units (ICUs) increases with age.
- Older individuals often exhibit higher basal serum cortisol and a blunted response to adrenocorticotropin (ACTH) stimulation.
- Impaired adrenal response during critical illness can be life-threatening.
Purpose of the Study:
- To investigate the association between age and serum cortisol levels (basal and stimulated) in critically ill patients.
- To compare adrenal function in younger versus older critically ill patients.
Main Methods:
- Two groups of surgical ICU patients with hypotension were studied: younger (<30 years) and older (>60 years).
- Serum cortisol levels were measured at baseline and after low-dose (1 microg) and standard-dose (250 microg) ACTH stimulation.
- Incidence of adrenal insufficiency and clinical variables were compared between groups.
Main Results:
- Older patients showed a significantly smaller cortisol response to both low-dose and standard-dose ACTH stimulation.
- Baseline serum cortisol tended to be higher in older patients, but this was not statistically significant.
- No significant difference in the incidence of adrenal insufficiency was observed between age groups.
Conclusions:
- Older critically ill patients exhibit a reduced adrenal response to ACTH stimulation.
- Findings suggest potential age-related changes in adrenal function during critical illness.
- Further research in larger cohorts is needed to confirm these findings and elucidate their clinical significance, possibly related to renal function decline.