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No Blood Testing in Relative Adrenal Insufficiency: Just Treat!

In their recent article, Djillali Annane and colleagues report that 83.5% of the septic patients they studied with the cosyntropin and metyrapone stimulation tests have primary or secondary adrenal insufficiency (respectively, 12.5 and 71%) (1). In their editorial in the same issue, Nuala J. Meyer and Jesse B. Hall conclude that we now have been provided with an elegant algorithm for the diagnosis of (relative) adrenal insufficiency in severe sepsis and septic shock (2).

Given the fact that more than 80% of the septic patients studied appear to have (relative) adrenal insufficiency and that low-dose steroids have beneficial effects on hemodynamics and few side effects, we think it is even easier to skip these stimula- tion tests and just start low-dose steroid treatment (3–5)!

Jack J. M. Ligtenberg, Arjanne Stemerdink and Jan G. Zijlstra

University Medical Center Groningen, Groningen, The Netherlands

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Annane D, Maxime V, Ibrahim F, Alvarez JC, Abe E, Boudou P. Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med 2006;174:1319–1326.[Abstract/Free Full Text]
2. Meyer NJ, Hall JB. Relative adrenal insufficiency in the ICU: can we at least make the diagnosis? Am J Respir Crit Care Med 2006;174:1282–1284.[Free Full Text]
3. Morel J, Venet C, Donati Y, Charier D, Liotier J, Frere-Meunier D, Guyomarc'h S, Diconne E, Bertrand JC, Souweine B, et al. Adrenal axis function does not appear to be associated with hemodynamic improvement in septic shock patients systematically receiving glucocorticoid therapy. Intensive Care Med 2006;32:1184–1190.[CrossRef][Medline]
4. Ligtenberg JJ, Monteban-Kooistra WE, Meertens JH, Tulleken JE, Zijlstra JG. The ACTH test should not be used in the decision to start low dose steroids in catecholamine-dependent septic shock. Intensive Care Med (In press)
5. Marik PE. The diagnosis of adrenal insufficiency in the critically ill patient: does it really matter? Crit Care 2006;10:176.[CrossRef][Medline]

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