Adrenocortical function during XXXX .

@entity1 @entity326 @entity25188 @entity1887 @entity1503 @entity5343 @entity701 @entity99
OBJECTIVE: To investigate, in @entity1 with severe @entity326 , the adrenocortical function assessed by daily plasma @entity701 determinations during the first 72 h and by the short synthetic ACTH stimulation test performed within 24 h of the onset of shock. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit in a university teaching hospital. @entity1 : 40 consecutive @entity1 with documented @entity326 requiring at least hemodynamic resuscitation and respiratory support. INTERVENTIONS: There were no interventions. MEASUREMENTS AND RESULTS: Basal @entity701 concentrations were increased with a mean value of 36.8 micrograms/dl (range 7.9-113). Of the overall @entity701 determinations 92% were above 15 micrograms/dl. No statistically significant differences in basal @entity701 concentrations were found when survival, type of @entity1503 were considered. @entity1 with @entity99 had significantly higher @entity701 (50.1 (+/- 6.2) micrograms/dl versus 35.9(+/- 3.3) micrograms/dl, p = 0.035) levels compared to other @entity1 . No correlations were found between basal plasma @entity701 concentrations and factors such as SAPS, @entity25188 , hemodynamic measurements, duration of shock, and amount of vasopressor and/or inotropic agents. @entity701 concentrations had significant but weak correlation with ACTH levels in survivors (r = 0.4; p = 0.03; n = 28) but not in non-survivors (r = 0.03; p = 0.85; n = 52). @entity701 levels in non-survivors increased significantly from enrollment time to the 72nd hour of the survey (day 1: 38.9(+/- 3.8) micrograms/dl versus day 3: 66.7(+/- 17.1) micrograms/dl; p = 0.046) and were significantly higher than those recorded in survivors. Responses to the short ACTH stimulation test were not significantly different between survivors and non-survivors. According to the different criteria used to interpret the response to the ACTH stimulation test, incidence of @entity5343 was highly variable ranging from 6.25-75% in @entity1 with @entity326 . Only one @entity1 had absolute @entity5343 (basal @entity701 level below 10 micrograms/dl; response to the ACTH stimulation test below 18 micrograms/dl). CONCLUSION: Our data suggest that in a selected population of @entity1 with severe @entity326 single plasma @entity701 determination has no predictive value. The short ACTH stimulation test performed within the first 24 h of onset shock can neither predict outcome nor estimate impairment in adrenocortical function in @entity1 with high basal @entity701 level. @entity1887 is rare in @entity326 and should be suspected when @entity701 level is below 15 micrograms/dl and then confirmed by a peak @entity701 level lower than 18 micrograms/dl during the short ACTH stimulation test.
