Septic Shock and Sepsis: A Comparison of Total and Free Plasma Cortisol Levels
Abstract
Context Severe systemic infection leads to hypercortisolism. Reduced cortisol binding proteins may accentuate the free cortisol elevations seen in systemic infection. Recently, low total cortisol increments after tetracosactrin have been associated with increased mortality and hemodynamic responsiveness to exogenous hydrocortisone in septic shock (SS), a phenomenon termed by some investigators as relative adrenal insufficiency (RAI). Hypothesis Free plasma cortisol may correspond more closely to illness severity than total cortisol, comparing SS and sepsis (S). Design This was a prospective study. Setting This study took place in a tertiary teaching hospital. Patients Patients had SS (n = 45) or S (n = 19) or were healthy controls (HCs; n = 10). Aim The aim of the study was to compare total with free cortisol, measured directly and estimated by Coolens' method, corticosteroid-binding globulin (CBG), and albumin in patients with SS (with and without RAI) and S during acute illness, recovery, and convalescence. Results Comparing SS, S, and HC subjects, free cortisol levels reflected illness severity more closely than total cortisol (basal free cortisol, SS, 186 vs. S, 29 vs. HC, 13 nmol/liter, P Conclusions Free cortisol is likely to be a better guide to cortisolemia in systemic infection because it corresponds more closely to illness severity. The attenuated cortisol increment after tetracosactrin in RAI is not due to low cortisol-binding proteins. Free cortisol levels can be…
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The cortisol level achieved by 50 mg IV hydrocortisone is greater than that reported in septic shock (mean, 880 nmol/l) or following major surgery such as coronary artery bypass surgery (median, 744 nmol/l).
“This level is greater than that reported in septic shock (mean, 880 nmol/l)55 or following major surgery such as coronary artery bypass surgery (median, 744 nmol/l).56”
From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [55]
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- Authors
- Ho, J. T., Al-Musalhi, H., Chapman, M. J., Quach, T., Thomas, P. D., Bagley, C. J., Lewis, J. G., & Torpy, D. J.
- Affiliations
- Hanson Institute (AU)
- Royal Adelaide Hospital (AU)
- Canterbury Health Laboratories (NZ)
- Corresponding author
- Ho, J. T.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-01
- Volume
- 91
- Issue
- 1
- Pages
- 105-114
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1983840348
- Cited by
- 312
- References
- 33
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 14 · 2019: 10 · 2018: 12 · 2017: 14 · 2016: 23 · 2015: 17 · 2014: 20 · 2013: 14 · 2012: 18
- FWCI
- 19.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Royal Adelaide Hospital
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- septic shock, sepsis, relative adrenal insufficiency, corticosteroid-binding globulin, albumin, hypercortisolism, disease severity, mortality, cortisol binding capacity, systemic infection, adrenal function
- MeSH terms
- Adrenal Insufficiency, Aged, Cosyntropin, Female, Humans, Hydrocortisone, Male, Middle Aged, Prospective Studies, Serum Albumin, Shock, Septic, Transcortin, Reproducibility of Results, Microdialysis, Sepsis
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