Ss. Chang et al., Adrenal insufficiency in critically ill emergency department patients: A Taiwan preliminary study, ACAD EM MED, 8(7), 2001, pp. 761-764
Objective: Unrecognized adrenal insufficiency can have serious consequences
in critically ill emergency department (ED) patients. This prospective pil
ot study of adrenal function in patients with severe illness was undertaken
to determine the prevalence of adrenal dysfunction and any relation to pri
or herbal drug use. Methods: In a high-volume urban tertiary care ED, adult
patients with sepsis or acute myocardial infarction (AMI) were eligible fo
r the study. Over a two-month period, a convenience sample was enrolled by
the authors on arrival to the ED. Inclusion criteria were systemic inflamma
tory response syndrome (SIRS) criteria plus evidence of at least one organ
dysfunction or cardiac marker plus electrocardiogram-proven AMI. Exclusion
criteria included known corticosteroid use. Serum cortisol was measured on
arrival and for those patients with a level of <15 <mu>g/dL (<414 nmol/L),
an adrenocorticotropic hormone (ACTH) stimulation test was performed. Resul
ts: Of the 30 enrolled patients, 23 (77%) were suffering from severe sepsis
and the other seven (23%) had an AMI. Thirteen of the 30 patients (43%; 95
% CI = 25% to 65%) had serum cortisol levels of <15 mug/dL, consistent with
adrenal insufficiency, nine with severe sepsis and four with an AMI. Eight
(62%; 95% CI = 32% to 86%) of the 13 patients with low cortisol levels rep
orted using herbal medications, while only two (12%; 95% CI = 1% to 36%) of
the 17 with normal cortisol levels reported taking herb drugs (p = 0.01).
Only two (15%; 95% CI = 2% to 45%) of the patients with low cortisol levels
failed their corticotropin stimulation test, suggestive of true adrenocort
ical insufficiency. Both reported using herbal preparations. Conclusions: T
hese results indicate that adrenal dysfunction is common among a group of c
ritically ill patients seen in this Taiwanese ED. Moreover, the use of herb
al drugs was high in the patients with low serum cortisols. Further studies
are required to both confirm these findings and clarify whether a number o
f herbal medications contain corticosteroids.