Angelis M, Yu M, Takanishi D, Hasaniya N W, Brown M R
University of Hawaii Integrated Surgical Residency Program, Honolulu, USA.
J Am Coll Surg. 1996 Dec;183(6):589-96.
Because hemodynamic instability may have several causes in critically ill patients, adrenal insufficiency may not be readily diagnosed. Eosinophilia has been described in patients with chronic adrenal insufficiency but not in critically ill patients. The goal of this study was to determine whether eosinophilia could serve as a marker of adrenal insufficiency in critically ill patients.
During a 1-year period, all surgical patients admitted to the surgical intensive care unit with an eosinophil count greater than 3 percent were prospectively studied. To diagnose adrenal insufficiency, the synthetic corticotropin (cosyntropin) stimulation test was used.
Eosinophilia was diagnosed in 31 patients, 7 (23 percent) of whom had adrenal insufficiency. The mean time interval to diagnosis was 13.7 days (range, 4 to 39 days). In 82 percent of the patients treated with hydrocortisone, a response was evidenced within 24 hours of treatment by a decrease in the required inotropic support by more than 50 percent, an increase in the mean arterial blood pressure of more than 25 percent, or both.
New-onset eosinophilia may be a useful marker for adrenal insufficiency. Prompt testing and diagnosis may avoid the occurrence of a treatable, life-threatening condition.
由于重症患者血流动力学不稳定可能有多种原因，肾上腺功能不全可能不易被诊断。慢性肾上腺功能不全患者中曾有嗜酸性粒细胞增多的描述，但重症患者中未见报道。本研究的目的是确定嗜酸性粒细胞增多是否可作为重症患者肾上腺功能不全的标志物。
在1年期间，对所有入住外科重症监护病房且嗜酸性粒细胞计数大于3%的外科患者进行前瞻性研究。采用合成促肾上腺皮质激素（考的松）刺激试验诊断肾上腺功能不全。
31例患者诊断为嗜酸性粒细胞增多，其中7例（23%）有肾上腺功能不全。诊断的平均时间间隔为13.7天（范围4至39天）。在接受氢化可的松治疗的患者中，82%在治疗后24小时内出现反应，表现为所需的血管活性药物支持减少超过50%，平均动脉血压升高超过25%，或两者兼有。
新发嗜酸性粒细胞增多可能是肾上腺功能不全的有用标志物。及时检测和诊断可避免发生可治疗的危及生命的疾病。
