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Normal adrenocortical function on initial testing in the intensive care unit: not a long-term warranty

Collection of reports on medical research published in the medical journal Critical Care helps you have more knowledge about medicine topics: Normal adrenocortical function on initial testing in the intensive care unit: not a long-warranty term | Available online http ccforum.eom content 12 4 163 Commentary Normal adrenocortical function on initial testing in the intensive care unit not a long-term warranty Pierre-Edouard Bollaert Service de Réanimation Médicale CHU de Nancy Nancy France Corresponding author Pierre-Edouard Bollaert pe.bollaert@chu-nancy.fr Published 2 July 2008 This article is online at http ccforum.com content 12 4 163 2008 BioMed Central Ltd Critical Care 2008 12 163 doi 10.1186 cc6926 See related research by Wu et al. http ccforum.com content 12 3 R65 Abstract There has been a lot of debate about the concept of relative adrenocortical insufficiency often defined as a reduced response to corticotropin as a pathophysiological explanation of steroid effects in septic shock. Less is known about the prevalence of absolute adrenocortical insufficiency based on more usual definitions low baseline and corticotropin stimulated cortisol . A study by Wu and colleagues provides convincing evidence that critically ill patients could evolve from a normal adrenal status towards very low cortisol levels within a few days. Although the exact consequences of these findings deserve more investigation adrenal testing should not be omitted in patients not improving their hemodynamic status. In the previous issue of Critical Care Wu and colleagues 1 report delayed adrenal insufficiency in 15 critically ill patients on the basis of a repeated plasma cortisol test among a prospective cohort of 53 patients who had normal or high cortisol levels on first testing and did not exhibit clinical improvement with treatment. Although 11 of these 15 patients received replacement doses of steroids they had a longer length of stay in hospital and longer duration of mechanical ventilation. The authors must be congratulated for these findings which add a new piece in the complex puzzle of adrenocortical function steroid treatment and outcome in the intensive care unit ICU . The renewal of interest for adrenal testing in .