Relative adrenal insufficiency in patients with severe acute pancreatitis

Objective Inadequate cortisol levels and adrenal dysfunction may play a role in the pathophysiology of severe acute pancreatitis. This study aimed to analyse the incidence of relative adrenal insufficiency (RAI) in these patients, to identify factors associated with RAI and to describe how adrenal responsiveness affects outcome. Design Prospective observational multicenter study. Patients Twenty-five patients with severe acute pancreatitis. Interventions A short Synacthen test (SST) was performed within 5 days after admission to the hospital. The incidence of RAI, defined as an increment after SST of less than 9 μg/dl was the primary endpoint of the study. Serum cortisol was measured at baseline and at 30 and 60 min after administration of 250 μg adrenocorticotropic hormone. Measurements and results Median baseline cortisol level was 26.6 μg/dl, and increased to 43.2 μg/dl and 48.8 μg/dl after 30 min and 60 min respectively. RAI was found in 16% of all patients and in 27% of patients with organ dysfunction. Patients with RAI were more severely ill and had higher SOFA scores from days 4 to 7 after admission. All patients with RAI developed pancreatic necrosis, and all of them needed surgical intervention. Twenty-eight-day mortality was significantly higher in patients with RAI (75% vs. 5%, p = 0.007). Patients who died had a lower increment in cortisol levels after the SST than patients who survived. Conclusion RAI is frequent in patients with severe acute pancreatitis and organ dysfunction. It occurs in patients with more severe pancreatitis and is associated with increased mortality. An abstract of this work was presented at the 27th International Symposium on Intensive Care and Emergency Medicine (ISICEM) in Brussels, March 2007.