Hypothyroidism and adrenal insufficiency in sepsis and hemorrhagic shock

Abstract

Hypothesis: We hypothesized that hypothyroidism and adrenal insufficiency frequently occur together in critically ill patients. Design: A prospective observational study. Setting: Surgical intensive care unit of a university-affiliated tertiary referral center. Patients: Sixty-six consecutive patients with severe sepsis, septic shock, and hemorrhagic shock who required pulmonary artery catheterization for resuscitation were studied. Interventions: Thyrotropin and baseline cortisol levels were obtained at 3 AM followed by intravenous injection of 250 μg of cosyntropin, a synthetic adrenocorticotropic hormone derivative. A second measurement of the cortisol level was performed 1 hour later. Main Outcome Measures: Incidence of hypothyroidism and adrenal insufficiency and mortality. Results: Mean (SD) age was 62 (19) years. The mean (SD) Acute Physiology and Chronic Health Evaluation II score was 21 (5). Twenty-seven patients (40.9%) had severe sepsis, 31 (46.9%) had septic shock, and 8 (12.1%) had hemorrhagic shock. Five patients (7.6%) had hypothyroidism alone and 35 (53.0%) had only adrenal insufficiency. Eight patients (12.1%) had both hypothyroidism and adrenal insufficiency. All patients with endocrine abnormalities were treated. Mortality for the total group was 15 (22.7%) of 66 patients. Conclusion: There is a 12% incidence of simultaneous hypothyroidism and adrenal insufficiency in our study and the routine testing for both may be indicated in this population of critically ill patients.