Study of Prevalence and Predictive Factors of Adrenal Insufficiency in Patients Admitted to Medical Intensive Care Unit in a Tertiary Care Hospital of North Karnataka
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 2
Abstract
Introduction: Adrenal insufficiency is a rare, but potentially lethal disease if left untreated. Symptoms, signs and biological markers associated with adrenal insufficiency are well established but often missed, affecting patient outcome. This study aimed to assess the prevalence of, and factors associated with adrenal insufficiency among patients admitted to medical ICU. Material and Methods: All patients with suspected adrenal insufficiency in a medical ICU were screened with high-dose (250 μg) ACTH-stimulation tests. Cortisol values <550 nmol/l upon stimulation were considered diagnostic for adrenal insufficiency; history, clinical findings and biological parameters were recorded and analysed. Results: 45 (22.06%) patients of the 204 assesed, had confirmed adrenal insufficiency, with a Male: Female sex ratio of 1:1.4; maximum in older age group (62.2%); mean age being 57.92 years with 35.6% diabetics and 31.1% hypertensives. Most had primary diagnosis of bacterial sepsis with 33.3% gram negative, 15.6% gram positive sepsis and 20% tuberculosis. 62.3% patients were in hypotension requiring vasopressor support, with increased incidence of associated hyperkalaemia (57.8%), hyponatremia (62.2%) and acidosis (53.3%). Profound adrenal failure identified in 22.2%. The overall one week mortality 28.9%, despite optimal supportive management. Conclusions: Confirmed adrenal insufficiency was observed in 22.06% of patients admitted in intensive care unit, associated and complicated by bacterial sepsis, including tuberculosis in 68.9% cases, with overall one week mortality of 28.9%. Combination of hypotension, hyperkalemia, hyponatremia and acidosis in an intensive care patient should prompt clinicians to suspect adrenal insufficiency, as early detection and optimal management would improve the overall outcome in such patients.
Authors and Affiliations
Durgaprasad M. Kabade, Savitri D. Kabade, Appu Abraham
Keywords
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