Jurney T H, Cockrell J L, Lindberg J S, Lamiell J M, Wade C E
Chest. 1987 Aug;92(2):292-5. doi: 10.1378/chest.92.2.292.
Recent reports suggest adrenal insufficiency in critically ill patients is common. We found only one case of de novo adrenal insufficiency using admission ACTH injection in 70 selected intensive care unit (ICU) patients. Random serum cortisol levels correlated positively with illness severity in ICU patients using proven methods for assessing illness severity. Those with the highest random serum cortisol levels (greater than 60 micrograms/dl) had the greatest mortality, while those with lower random cortisol levels which stimulated to more than 18 micrograms/dl after ACTH injection had improved outcomes. Based on our results, routine screening for adrenal insufficiency in ICU patients is not warranted. If it is suspected, the cosyntropin test should be performed since low random cortisol levels (even to 5 micrograms/dl) are not diagnostic of adrenal insufficiency.
近期报告显示，危重症患者中肾上腺功能不全很常见。在70例选定的重症监护病房（ICU）患者中，我们仅发现1例因入院时注射促肾上腺皮质激素（ACTH）而出现的新发肾上腺功能不全病例。采用已证实的疾病严重程度评估方法，ICU患者的随机血清皮质醇水平与疾病严重程度呈正相关。随机血清皮质醇水平最高（大于60微克/分升）的患者死亡率最高，而随机皮质醇水平较低但在注射ACTH后刺激升高至超过18微克/分升的患者预后较好。根据我们的结果，不建议对ICU患者进行肾上腺功能不全的常规筛查。如果怀疑有肾上腺功能不全，应进行促肾上腺皮质激素试验，因为随机皮质醇水平低（甚至低至5微克/分升）并不能诊断肾上腺功能不全。
