Introduction: Functional integrity of the hypothalamic pituitary axis is disrupted during severe infection or stress. The observed blunted response to corticotropin was interpreted as impaired secretory reserve of the adrenal glands and was termed as relative adrenocortical insufficiency. Aim of the work:To study the incidence of adrenal insufficiency in patients developed cardiogenic shock complicating ST segment elevation myocardial infarction.Materials and methods:Prospective cohort study was done for 90 patients admitted to Algalaa Hospital forwhombasal cortisol and ACTH level were measured immediately before a standard-dose (250 μg) ACTH stimulation test (SST) and 60 minutes after SST Δmax is defined as the difference between the maximal value after the test and basal level of serum cortisol. Results: Baseline ACTH and total cortisol showed positive correlation to clinical severity scores (APACHE II and Lactate), LVEF as well as vasoactive inotrope score,all with significant p value (0.000). The higher baseline cortisol level was co-related to increased mortality(Baseline serum cortisol level was significantly lower in survivors (30.6±6.1 vs45.0±
References
[1]
Boonen, E., Vervenne, H., Meersseman, P., Andrew, R., Mortier, L., Declercq, P.E., Vanwijngaerden, Y.M., Spriet, I., Wouters, P.J., Vander Perre, S., et al. (2013) Reduced Cortisol Metabolism during Critical Illness. The New England Journal of Medicine, 368, 1477-1488. https://doi.org/10.1056/NEJMoa1214969
[2]
Annane, D., Sébille, V., Troché, G., Raphael, J.C., Gajdos, P. and Bellissant, E. (2000) A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin. JAMA, 283, 1038-1045.
https://doi.org/10.1001/jama.283.8.1038
[3]
Babaev, A., Frederick, P.D., Pasta, D.J., et al. (2005) Trends in Management and Outcomes of Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA, 294, 448-454. https://doi.org/10.1001/jama.294.4.448
[4]
Knaus, W.A., Draper, E.A., Wagner, D.P. and Zimmerman, J.E. (1985) APACHE II: A Severity of Disease Classification System. Critical Care Medicine, 13, 818-829.
https://doi.org/10.1097/00003246-198510000-00009
[5]
Tol, M.M., Shekar, K., Barnett, A.G., McGree, J., McWhinney, B.C., Ziegenfuss, M., Ungerer, J.P. and Fraser, J.F. (2014) A Preliminary Investigation into Adrenal Responsiveness and Outcomes in Patients with Cardiogenic Shock after Acute Myocardial Infarction. Journal of Critical Care, 29, 470.e1-470.e6.
https://doi.org/10.1016/j.jcrc.2014.01.020
[6]
Jayaraj, J.C., Davatyan, K., Subramanian, S.S. and Priya, J. (2018) Epidemiology of Myocardial Infarction. IntechOpen, London.
https://doi.org/10.5772/intechopen.74768
[7]
Tsai, M.-H. (2009) Critical Illness-Related Corticosteroid Insufficiency in Patients with Severe Acute Biliary Pancreatitis: A Prospective Cohort Study. Critical Care, 13, R123. https://doi.org/10.1186/cc7978
[8]
Cooper, M.S. and Stewart, P.M. (2003) Corticosteroid Insufficiency in Acutelyill Patients. The New England Journal of Medicine, 348, 727-734.
https://doi.org/10.1056/NEJMra020529
[9]
Jurney, T.H., Cockrell, J.L., Lindberg, J.S., Lamiell, J.M. and Wade, C.E. (1987) Spectrum of Serum Cortisol Response to ACTH in ICU Patients. Correlation with Degree of Illness and Mortality. Chest, 92, 292-295.
https://doi.org/10.1378/chest.92.2.292
[10]
Ryu, D.-R. and Chung, J.H. (2011) Yonsei Medical Journal, 52, 595-602.
[11]
Harry, R., Auzinger, G. and Wendon, J. (2002) The Clinical Importance of Adrenal Insufficiency in Acute Hepatic Dysfunction. Hepatology, 36, 395-402.
https://doi.org/10.1053/jhep.2002.34514
[12]
Marik, P.E., Pastores, S.M., Annane, D., Meduri, G.U., Sprung, C.L., Arlt, W., Keh, D., Briegel, J., Beishuizen, A., Dimopoulou, I., Tsagarakis, S., Singer, M., Chrousos, G.P., Zaloga, G., Bokhari, F. and Vogeser, M. (2008) Recommendations for the Diagnosis and Management of Corticosteroid Insufficiency in Critically Ill Adult Patients: Consensus Statements from an International Task Force by the American College of Critical Care Medicine. Critical Care Medicine, 36, 1937-1949.
https://doi.org/10.1097/CCM.0b013e31817603ba
