Adrenal Insufficiency in Cardiogenic Shock: Incidence and Prognostic Implication - World Journal of Cardiovascular Diseases

WJCD > Vol.9 No.8, August 2019

Adrenal Insufficiency in Cardiogenic Shock: Incidence and Prognostic Implication ()

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Download as PDF (Size: 1087KB) PP. 562-571

DOI: 10.4236/wjcd.2019.98049 631 Downloads 1,774 Views

Author(s)

Emad Omer, Hanan Zaghla

Affiliation(s)

Critical Care Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt.

ABSTRACT

Introduction: Functional integrity of the hypothalamic pituitary axis is disrupted during severe infection or stress. The observed blunted response to corticotropin was interpreted as impaired secretory reserve of the adrenal glands and was termed as relative adrenocortical insufficiency. Aim of the work: To study the incidence of adrenal insufficiency in patients developed cardiogenic shock complicating ST segment elevation myocardial infarction. Materials and methods: Prospective cohort study was done for 90 patients admitted to Algalaa Hospital for whom basal cortisol and ACTH level were measured immediately before a standard-dose (250 μg) ACTH stimulation test (SST) and 60 minutes after SST Δmax is defined as the difference between the maximal value after the test and basal level of serum cortisol. Results: Baseline ACTH and total cortisol showed positive correlation to clinical severity scores (APACHE II and Lactate), LVEF as well as vasoactive inotrope score, all with significant p value (0.000). The higher baseline cortisol level was co-related to increased mortality (Baseline serum cortisol level was significantly lower in survivors (30.6 ± 6.1 vs 45.0 ± 16.3) p value: 0.000) while the better response of the adrenal gland to short stimulation test was co-related more to survival as detected by Δmax TC (difference of cortisol level before and after SST) (13.8 ±3.8 in survivors vs 8.5 ± 4.42 in non survivors) p value 0.000. Conclusion: A high baseline plasma TC was associated with increased mortality in patients with cardiogenic shock post acute myocardial infarction. Patients with lower baseline TC, but with a better adrenal response, appeared to have a survival benefit.

KEYWORDS

Adrenal Insufficiency, Cardiogenic Shock, Myocardial Infarction, Short Stimulation Test, Cortisol, ACTH

Share and Cite:

Omer, E. and Zaghla, H. (2019) Adrenal Insufficiency in Cardiogenic Shock: Incidence and Prognostic Implication. World Journal of Cardiovascular Diseases, 9, 562-571. doi: 10.4236/wjcd.2019.98049.

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