Hypothyroidism and adrenal insufficiency in sepsis and hemorrhagic shock.

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.