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Adrenocortical function during septic shock

G Bouachour1, P Tirot, J P Gouello

  • 1Service de Réanimation Médicale, Centre Hospitalier Universitaire, Angers, France.

Intensive Care Medicine
|January 1, 1995
PubMed
Summary
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In severe septic shock, a single plasma cortisol test offers no predictive value. The ACTH stimulation test within 24 hours cannot predict outcomes or assess adrenal function in patients with high cortisol levels.

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Septic Shock Research

Background:

  • Severe septic shock is a life-threatening condition characterized by circulatory, cellular, and metabolic abnormalities.
  • Adrenocortical function is crucial in managing septic shock, but its assessment remains complex.
  • Understanding cortisol levels and adrenal response is vital for predicting patient outcomes.

Purpose of the Study:

  • To evaluate the role of plasma cortisol levels and the ACTH stimulation test in assessing adrenocortical function in severe septic shock patients.
  • To determine if these assessments can predict patient outcomes or identify adrenal insufficiency.

Main Methods:

  • A prospective study involving 40 consecutive patients with severe septic shock in a medical intensive care unit.

Related Experiment Videos

  • Daily plasma cortisol measurements were taken during the first 72 hours.
  • A short synthetic ACTH stimulation test was administered within 24 hours of shock onset.

    • Main Results:

    • Basal cortisol concentrations were elevated in most patients (92% > 15 micrograms/dl).
    • No significant correlation was found between basal cortisol levels and patient survival, infection type, or blood culture status.
    • Cortisol levels in non-survivors increased significantly over 72 hours and were higher than in survivors, but the ACTH test showed no significant difference in response between groups.
    • Adrenocortical insufficiency was rare, identified in only one patient based on strict criteria.

    Conclusions:

    • Single plasma cortisol measurements lack predictive value in severe septic shock.
    • The early ACTH stimulation test is not reliable for predicting outcomes or assessing adrenal function in patients with high basal cortisol.
    • Adrenal insufficiency in septic shock is uncommon and should be suspected only when basal cortisol is < 15 micrograms/dl and the ACTH test yields a peak < 18 micrograms/dl.