Endocrine Abstracts

Introduction: Relative adrenal insufficiency is considered a life threatening event, especially when associated with a serious event like trauma. Recognition and treatment of relative adrenal insufficiency is a challenge for clinical practitioner.

Objectives: We wanted to study adrenal dysfunction, diagnostic methods corresponding to the emergency situation for a trauma patient, adaptative capability of hypothalamic–pituitary–adrenal axis and therapeutic methods for trauma patients.

Materials and methods: We studied 15 patients brought to the Emergency Department. We determined basal serum cortisol and after 1 μg tetracosactide (Synachten) stimulation test – we measured cortisol at 15 min and then at 60 min. We appreciated survival rate function basal and stimulated cortisol values.

Results: For 9 patients (group A) basal cortisol levels (7.37 μg/dl) and stimulated cortisol levels (11.30 μg/dl) were lower than normal. For 3 patients (group B), basal cortisol levels were less than normal (8.11 μg/dl), but after the stimulation test – levels were normal (20.71 μg/dl). For 3 patients (group C), basal (14.53 μg/dl) and stimulated (25.05 μg/dl) cortisol levels were both normal.

Survival rate was 22% for group A, 33% for group B and 100% for group C. All patients received i.v. hydrocortisone 100–200 mg daily.

We observed a high mortality rate for those patients with low cortisol values and adaptative cortisol dysfunction as for those with adequate basal and stimulated cortisol values. It still remains the problem of using a cortisone dose for treatment that is lower than it should be for the adaptative capability.

Conclusions: Relative adrenal insufficiency is a stress-induced situation. A high clinical suspicion, a correct diagnosis and cortisone replacement could higher the survival rate.