ADRENAL INSUFFICENCY IN PATIENTS WITH LOW SYSTOLIC BLOOD PRESSUE AND FEATURES OF SIRS OR SEPSIS

Deni Joseph; Harris P; Feroz P Jenner

Volume : V, Issue : X, October - 2016

ADRENAL INSUFFICENCY IN PATIENTS WITH LOW SYSTOLIC BLOOD PRESSUE AND FEATURES OF SIRS OR SEPSIS

Deni Joseph, Harris P, Feroz P Jenner

Abstract :

<p>&nbsp;Sepsis is one of the most common and prevalent conditions in the intensive care unit which is associated with high rate of morbidity and mortality. Sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instability. Critical illness-related corticosteroid insufficiency (CIRCI) is associated with a poor prognosis. Through this study efforts were made to determine the prevalence of relative adrenocortical insufficiency in critically patient with features of SIRS or sepsis. A cross sectional study was conducted among patients admitted to the medical intensive care unit to detect adrenal insufficiency using the 1mcg ACTH test (Synacthen test) in patients with low systolic blood pressure(&le; 90 mmof Hg) and features of sepsis or systemic inflammatory response syndrome (SIRS). High proportion of critically ill patients with systolic blood pressure &le; 90 mm of Hg were noted to have relative adrenal insufficiency with 63.3% positive after Synacthen test. A statistically significant mean increment of 10.97mcg/dL was noted. The high percentage of relative adrenal insufficiency in this study suggests that vast majority of patients who are dependent on vasopressors are not capable of mounting a cortisol response adequate for the amount of stress.</p>