Open AccessRelative Adrenal Insufficiency in the Critical Care Setting: Debunking the Classic Myth
Author(s) -
Kromah Fatuma,
Tyroch Alan,
McLean Susan,
Hughes Harold,
Flavin Nina,
Lee Soyoung
Publication year - 2011
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-011-1126-3
Subject(s) - medicine , hyponatremia , hyperkalemia , adrenal insufficiency , hypernatremia , eosinophilia , hypokalemia , adrenal crisis , hypoglycemia , eosinopenia , intensive care unit , gastroenterology , endocrinology , anesthesia , sodium , chemistry , organic chemistry , insulin
Background Classic teaching states that chronic adrenal insufficiency is associated with hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, and eosinophilia. We hypothesize that these diagnostic markers do not predict relative adrenal insufficiency (RAI) in the critically ill or injured patient. Methods Chart review of surgical, trauma, and medical patients admitted over 7 years to a critical care unit was performed to evaluate cortisol levels drawn for suspicion of RAI, which was defined as a cortisol concentration <25 mcg/dl. Laboratory parameters were defined as hyponatremia <135 mmol/l, hyperkalemia >5.3 mmol/l, hypercalcemia >2.55 mmol/l (10.2 mg/dl), hypoglycemia <3.89 mmol/l (70 mg/dl), and eosinophilia >5%. Results A total of 212 patients had cortisol levels drawn. Fifty‐seven percent were male and their mean age was 59 years. Fifty‐three percent had RAI. Average cortisol level was 30.5 μg/dl. No significant differences were seen in mean potassium, sodium, calcium, or glucose levels between RAI and non‐RAI patients. Few patients had laboratory values consistent with RAI. In fact, many with RAI had opposite findings: 75% had hypernatremia, 90% had hypokalemia, 100% had hypocalcemia, and 97% had hyperglycemia. Eosinophilia was statistically significant ( P = 0.026). Conclusion Hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia do not predominate in RAI and laboratory values are of minimal value in predicting patients with RAI.