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Variable adrenocortical function in acute medical illness.

D Drucker, M Shandling

    Critical Care Medicine
    |June 1, 1985
    PubMed
    Summary
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    Acute medical illness commonly elevates cortisol levels, but this does not necessarily correlate with illness severity. Surviving patients showed lower cortisol levels than those who did not survive.

    Area of Science:

    • Endocrinology
    • Critical Care Medicine
    • Internal Medicine

    Background:

    • Acute medical illness can significantly alter endocrine function.
    • Adrenocortical function and reserve in medical intensive care unit (ICU) patients are not well understood.
    • Cortisol levels are known to rise during acute illness.

    Purpose of the Study:

    • To evaluate plasma adrenocorticotropic hormone (ACTH) and cortisol levels in acutely ill patients.
    • To assess cortisol response to intravenous ACTH in medical ICU patients.
    • To compare endocrine function between acutely ill patients and healthy controls.

    Main Methods:

    • Plasma ACTH and cortisol levels were measured in 40 acutely ill patients and 20 non-acutely ill controls.
    • Cortisol response to intravenous ACTH was evaluated.

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  • Patients were categorized based on survival status.

    • Main Results:

    • A wide range of plasma cortisol values was observed (212 to 8430 nmol/L).
    • Higher plasma cortisol levels were not consistently associated with greater illness severity.
    • Patients who survived hospitalization had lower mean initial and post-ACTH cortisol levels compared to non-survivors.
    • ACTH levels showed wide variation and poor correlation with plasma cortisol.
    • No evidence of occult adrenocortical insufficiency was found.

    Conclusions:

    • Elevated plasma cortisol is a common finding in acute medical illness.
    • Cortisol levels and response to ACTH may have prognostic implications in critically ill patients.
    • Further research is needed to clarify the role of cortisol in acute illness and its impact on patient outcomes.