@entity1887 during XXXX .

@entity1 @entity326 @entity1887 @entity134 @entity701
OBJECTIVE: To determine whether a baseline (random) @entity701 concentration <25 microg/dL in @entity1 with @entity326 was a better discriminator of @entity1887 than the standard (250 microg) and the low-dose (1 microg) corticotropin stimulation tests as assessed by the hemodynamic response to @entity134 replacement. SETTING: Intensive care unit. @entity1 : Fifty-nine @entity1 with @entity326 . Their mean age was 57 +/- 16.7 yrs; 29 were male. INTERVENTIONS: A baseline @entity701 concentration was obtained. @entity1 then received an intravenous injection of 1 microg of corticotropin (low-dose test) followed 60 mins later by an injection of 249 microg of corticotropin (high-dose test). @entity701 concentrations were obtained 30 and 60 mins after low- and high-dose corticotropin. All @entity1 were administered @entity701 (100 mg every 8 hrs) for the first 24 hrs while awaiting results of @entity701 assessment. @entity1 were considered @entity134 responsive if the pressor agent could be discontinued within 24 hrs of the first dose of @entity701 . MEASUREMENTS AND MAIN RESULTS: Forty-seven percent of @entity1 died. Twenty-two percent of @entity1 met the diagnostic criteria of @entity1887 by the low-dose test and 8% by the high-dose test. However, 61% of @entity1 met the criteria of @entity1887 when we used a baseline @entity701 concentration of <25 microg/dL. Twenty-two @entity1 (37%) were @entity134 responsive; the baseline serum @entity701 was 14.1 +/- 5.2 microg/dL in the @entity134 -responsive @entity1 compared with 33.3 +/- 18 microg/dL in the @entity134 -nonresponsive @entity1 (p <.0001). Ninety-five percent of @entity134 -responsive @entity1 had a baseline @entity701 concentration <25 microg/dL. Fifty-four percent of @entity134 responders had a diagnostic low-dose test and 22% a diagnostic high-dose test. Receiver operating characteristic curve analysis revealed that a stress @entity701 concentration of 23.7 microg/dL was the most accurate diagnostic threshold for determination of the hemodynamic response to glucocorticoid therapy. CONCLUSIONS: @entity1887 is common in @entity1 with @entity326 , the incidence depending largely on the diagnostic test and criteria used to make the diagnosis. There is clearly no absolute serum @entity701 concentration that distinguishes an adequate from an insufficient adrenal response. However, we believe that a random @entity701 concentration of <25 microg/dL in a highly stressed @entity1 is a useful diagnostic threshold for the diagnosis of @entity1887 .
