EOSINOPHILA AS A MARKER OF ADRENAL INSUFFICIENCY IN THE SURGICAL INTENSIVE-CARE UNIT

BACKGROUND: Because hemodynamic instability may have several causes in critically ill patients, adrenal insufficiency may not be readily dia gnosed. Eosinophilia has been described in patients with chronic adren al insufficiency but not in critically ill patients. The goal of this study was to determine whether eosinophilia could serve as a marker of adrenal insufficiency in critically ill patients. STUDY DESIGN: Durin g a 1-year period, all surgical patients admitted to the surgical inte nsive care unit with an eosinophil count greater than 3 percent were p rospectively studied, To diagnose adrenal insufficiency, the synthetic corticotropin (cosyntropin) stimulation test was used. RESULTS: Eosin ophilia was diagnosed in 31 patients, 7 (23 percent) of whom had adren al insufficiency. The mean time interval to diagnosis was 13.7 days (r ange, 4 to 39 days). In 82 percent of the patients treated vith hydroc ortisone, a response was evidenced within 24 hours of treatment by a d ecrease in the required inotropic support by more than 50 percent, an increase in the mean arterial blood pressure of more than 25 percent, or both. CONCLUSIONS: New-onset eosinophilia may be a useful marker fo r adrenal insufficiency. Prompt testing and diagnosis may avoid the oc currence of a treatable, life-threatening condition.