To Study the Prevalance of Occult Adrenal Insufficiency in Patients of Septic Shock

Septic shock remains the most common cause of death in non coronary Intensive Care Unit (ICU). A study was conducted in ICU department of Fortis Escorts hospital Faridabad in the year July 2004-Dec 2005 in order to evaluate the prevalence of occult Adrenal Insufficiency in 25 cases of septic shock using the short ACTH stimulation test. Basal cortisol level at admission followed by I/V injection of 250μg ACTH and another sample at 60min after I/V ACTH was taken. Out of 25 patients, 3 {12%} had baseline cortisol less than 20μg/dl and were therefore classified as having Adrenal insufficiency. Of the remaining 22patients, 8 patients had baseline cortisol > 20μg and êmax < 9μg/dl, were categorized into Functional Hypoadrenalism and rest of 14 pts baseline cortisol < 20μg/dl and êmax > 9μg/dl thus demonstrating preserved adrenal function in response to critical illness. The overall mortality was 48%. However it was 100% in AI group. Sepsis can cause occult AI in the presence of normal/even elevated serum Cortisol.