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Adrenal insufficiency in hemorrhagic shock
G D Rushing1, R C Britt, J N Collins
1Department of Surgery, Eastern Virginia Medical School, Norfolk 23507, USA.
The American Surgeon
|July 1, 2006
Summary
Relative adrenal insufficiency is common in patients experiencing hemorrhagic shock. This condition, defined by low random serum cortisol levels, warrants further investigation into its causes and potential treatments.
Area of Science:
- Trauma critical care
- Endocrinology
- Shock pathophysiology
Background:
- Adrenal insufficiency is a known complication of sepsis.
- The link between hemorrhagic shock and adrenal insufficiency is not well understood.
- Potential causes include ischemia, necrosis, or resuscitation effects.
Purpose of the Study:
- To determine the incidence of relative adrenal insufficiency in patients with hemorrhagic shock.
- To analyze the association between hemorrhagic shock and adrenal insufficiency.
- To identify potential factors influencing this relationship.
Main Methods:
- Retrospective review of a prospectively gathered trauma intensive care unit database.
- Inclusion criteria: patients admitted with hemorrhagic shock.
- Definition of relative adrenal insufficiency: random serum cortisol <25 mcg/dL within 24 hours of admission.
Main Results:
- Fifteen patients with hemorrhagic shock were analyzed.
- Fourteen out of 15 patients (93%) met criteria for relative adrenal insufficiency.
- Average serum cortisol was 15.8 mcg/dL; average APACHE II score was 18.3; average Injury Severity Score was 22.5.
Conclusions:
- Relative adrenal insufficiency is highly prevalent in hemorrhagic shock.
- Further research is needed to understand the underlying pathophysiology.
- Prospective studies should evaluate the potential benefits of steroid replacement therapy.
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