Endocrine Abstracts

Introduction: Acute myocardial infarction (AMI) is a stressful condition in which it stimulates the hypothalamus-pituitary-adrenal axis leading to mark increase in the production of cortisol. Adrenal insufficiency (AI) has been shown to be associated with morbidity and mortality in acute coronary syndrome patients. To date, none study has been performed to determine prevalence of AI among patient with AMI.

Objectives: The aim of this study is to determine the prevalence of AI in AMI by using the low dose (LD) and standard dose (SD) synacthen tests and to correlate with morbidity and mortality.

Method: Fifty-six patients who fulfilled the diagnosis of AMI within 48 h of onset were subjected to LD (1 μg) synacthen test (LDST) followed by a SD (250 μg) synacthen test (SDST) 2-h later. Those who had AI, repeat synacthen test had to perform at day 30 of AMI.

Result: Thirty-five (62.5%) patients had ST elevation AMI and 21 (35.5%) non-ST elevation AMI. Using an increment of <250 nmol/l following LDST and SDST, 39 (69.6%) and 2 (3.6%) patients had adrenal insufficiency respectively. Based on LDST, the diagnosis of AI was associated with significant morbidity and mortality. One patient died during the study period and he had very high cortisol levels. Out of 15 patients who underwent repeat synacthen, only two of them had responded to the synacthen test.

Conclusion: Utilising the LDST, adrenal insufficiency was found in 69.6% of AMI patients. Mortality of AMI showed less cortisol increment to LDST but able to reach the peak cortisol level for both tests. Functional AI in AMI takes longer than 30 days to recover.

Disclosure: This study was approved by Research and Ethics committee of the Faculty of Medicine, UKM and the project code was FF-2014-214. Funding for this study was provided by the research Grant of Faculty Of Medicine UKM.