Abstract
Objective
To explore the relationship between cholesterol levels and the adrenal cortisol response to synacthen in critically ill patients.
Design
Prospective observational study.
Patients
Critically ill patients with multiple organ dysfunction syndrome (MODS) with possible adrenal dysfunction defined as unexplained hypotension, ongoing inotropic support, unexplained fever, unexplained hyponatraemia or a combination of these symptoms.
Measurements
HDL-cholesterol levels (HDL), total cholesterol levels (TC), and triglycerides (TG) before administration of synacthen. LDL-cholesterol was calculated using the Friedewald formula. Basal cortisol and response to 250 μg synacthen intravenously was measured. A cortisol rise of 0.25 μmol/l in a 30-min or 60-min blood sample after synacthen infusion was defined as a proper adrenal response.
Results
Patients with a proper response to synacthen showed higher HDL-cholesterol levels than patients without that response (P=0.02). Severity of disease as measured by APACHE II or SOFA was not a confounder. LDL-cholesterol levels were extremely low in both responders and non-responders and were not associated with the absolute rise in cortisol. In linear and logistic regression analysis HDL-cholesterol was the sole predictor of cortisol response.
Conclusions
Adrenal cortisol response to a “classic” 250-μg synacthen test relates in critically ill patients to HDL-cholesterol levels. LDL and TC levels did not show such a relation. These findings are in concordance with known biochemical pathways of cortisol production.
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van der Voort, P.H.J., Gerritsen, R.T., Bakker, A.J. et al. HDL-cholesterol level and cortisol response to synacthen in critically ill patients. Intensive Care Med 29, 2199–2203 (2003). https://doi.org/10.1007/s00134-003-2021-7
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DOI: https://doi.org/10.1007/s00134-003-2021-7