Adrenal insufficiency in acute coronary syndrome

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.

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.

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.

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.