Reversible increase in maximal cortisol secretion rate in septic shock

Area of Science:

• Endocrinology
• Critical Care Medicine
• Pharmacokinetics

Background:

• Cortisol clearance is reduced in sepsis, potentially impairing adrenocortical function.
• Critical illness-related corticosteroid insufficiency is a recognized complication.
• Understanding adrenocortical dynamics is crucial in sepsis pathophysiology.

Purpose of the Study:

• To assess adrenocortical function in septic shock, sepsis, and healthy controls.
• To characterize and compare maximal cortisol secretion rate and free cortisol half-life.
• To utilize computer-assisted numerical modeling for kinetic parameter assessment.

Main Methods:

• Post hoc analysis of previously collected cortisol, corticosteroid-binding globulin, and albumin data.
• Subjects included patients with septic shock (n=45), sepsis (n=25), and healthy controls (n=10).
• Intravenous cosyntropin (250 μg) was administered.

Main Results:

• Maximal cortisol secretion rate was significantly higher in septic shock compared to sepsis and controls.
• The variance of maximal cortisol secretion rate was also greater in septic shock.
• Free cortisol half-life was significantly increased in both septic shock and sepsis groups compared to controls.

Conclusions:

• Numerical modeling results align with gold-standard methods.
• Septic shock exhibits higher maximal cortisol secretion rate with greater variance.
• Further research is needed to determine the diagnostic and management utility of cortisol kinetic parameters in critical illness.