Outcome of the ACTH test permitted to distinguish 3 groups of individuals. Six sufferers have

Outcome of the ACTH test permitted to distinguish 3 groups of individuals. Six sufferers have sufficient adrenal response: high basal serum Cambinol custom synthesis cortisol level which boost soon after ACTH’s injection. Hydrocortisone is stopped. Evolution within this group is normally favorable (one hundred ). Thirteen individuals possess a relative adrenal insufficiency: normal or high serum cortisol level but using a weak enhance soon after the test. Hydrocortisone is maintained for 5 days. Evolution is favorable in nine patients (69 ). Two patients with extremely high serum cortisol level, had quickly fatal evolution. Conclusion: The ACTH test have to be realized at the sufferers in state of septic shock to find out these that may benefit from a contribution of corticoids.P221 Decreased cortisol in acute liver failure is not resulting from pituitary failure or lowered binding proteinsR Harry, G Auzinger, J Wendon Institute of Liver Research, Kings College Hospital, London SE5 5RS, UK Decreased cortisol is common in patients with acute liver failure (ALF). The aetiology of this phenomenon is unclear, relating potentially to decreased levels of cortisol binding proteins, pituitary or adrenal dysfunction. We examined the relative importance of these variables.Essential CareVol 6 Suppl22nd International Symposium on Intensive Care and Emergency MedicineMethods: Twenty individuals with ALF, admitted to a 10 bedded specialist liver intensive care unit, have been investigated. We sampled blood at 9:00 a.m. and measured total cortisol, ACTH and also the two key binding proteins CBG and albumin at the same time as regular biochemistry. Cholesterol was measured as precursor of cortisol synthesis. From these information, the unbound cortisol was calculated. Regular ranges are: cortisol > 250 nmol/l, CBG 39.7 ?6.3 /l for males and 42.two ?5.6 /l for females, ACTH 39 pg/ ml (range < 25?5), albumin 35?0 g/l. Absolute values are given as median and interquartile range. Comparisons were performed using the Mann hitney U test and correlations using the Spearman Rank Correlation coefficient. Results: All patients had CBG below the normal range (BNR) and albumin was BNR in 19/20 patients. Fifty percent of patients had a total cortisol BNR all of whom also had a free cortisol BNR. All patients with normal cortisol had normal free cortisol. Cholesterol, albumin, and CBG were all significantly lower in patients with cortisol BNR (Table). The CBG was significantly correlated with total cortisol (R = 0.519, P < 0.05). ACTH is above normal range in 18/20 patients and was higher in those with cortisol above 250 nmol/l (Table).Table Total cortisol BNR Cholesterol Albumin CBG ACTH 1.05 (0.4?) 13.5 (9?7) 12.85 (10?5) 41 (31?1) Normal total cortisol 1.9 (2?) 18.5 (17?3) 22.4 (17?0) 60 (52?69) P < 0.005 < 0.025 < 0.005 0.Conclusion: In ALF, reduced total cortisol is accompanied by reduced free cortisol despite reduced CBG and albumin. The ACTH results suggest adrenal dysfunction rather than pituitary failure as the cause of the reduction in total cortisol seen in these critically ill patients. In 36 patients, morning PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20725058 interleukin-6 (IL-6) concentrations had been also measured. Imply baseline and stimulated plasma cortisol have been 16.8 ?four.1 ?dl and 21.two ?five.1 /dl respectively. The median increment in cortisol was four.1 /dl. Median IL-6 was high (39.3 pg/ml, interquartile variety 24.9?six.six pg/ml). There was a unfavorable correlation between IL-6 and stimulated plasma cortisol (r = ?.40, P = 0.01). With the 43 sufferers, 31 individuals (72 ) have been responders, and 12 sufferers (28 ) were non-respon.