Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock
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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 mug 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.
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Serum testosterone falls abruptly and markedly in all critically ill men.
“Similarly, abrupt and profound decreases in serum testosterone are uniformly seen in critically ill men [74, 84–91].”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [86]
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Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury
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- Authors
- Ho, H. C.
- Affiliations
- University of Hawaiʻi at Mānoa (US)
- Corresponding author
- Ho, Hao Chih
- Venue
- Archives of Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2004-11-01
- Volume
- 139
- Issue
- 11
- Pages
- 1199
- ISSN
- 0004-0010 (ISSN-L)
- OpenAlex
- W1983146060
- Cited by
- 25
- References
- 49
- Citations by year
- 2025: 1 · 2023: 2 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Surgery (publishedVersion)
- PubMed (publishedVersion)
- UCLA - Biblioteca de Ciencias de la Salud (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- hypothyroidism, adrenal insufficiency, sepsis, septic shock, hemorrhagic shock, critically ill patients, ACTH stimulation test, cortisol, thyroid-stimulating hormone, mortality, endocrine disorders
- MeSH terms
- Adrenal Insufficiency, Adrenocorticotropic Hormone, Aged, Cosyntropin, Female, Humans, Hydrocortisone, Hypothyroidism, Injections, Intravenous, Male, Middle Aged, Prospective Studies, Shock, Hemorrhagic, Shock, Septic, Thyrotropin, Wounds and Injuries, Incidence, Critical Illness, Sepsis
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