Corresponding Author:
Pravat Kumar Thatoi,
Flat-104, Aryabhatta Complex,
College Square,
Cuttack-753003,
Odisha, India.
E-mail: drpravatthatoi@yahoo.co.in

ABSTRACT

BACKGROUND

Cortisol (Glucocorticoid) is the main hormone in host response to stress. Its secretion from adrenal glands depends on integrity of hypothalamic-pituitary-adrenal (HPA) axis. Adrenocorticotropic hormone (ACTH) is the stimulant for cortisol secretion from adrenal glands. Adrenal insufficiency (AI) is often present in critically ill patients and is diagnosed by ACTH stimulation test using intravenous (IV) injection of Synacthen (Tetracosactide) which is not freely available in our part. Another synthetic corticotrophin (Acton Prolongatum) prepared by Ferring pharmaceuticals can be used for intramuscular (IM) ACTH stimulation test for assessment of adrenal function.

Aims & Objectives- To measure the basal serum cortisol level at 8.00-9.00 a.m. then at 60 min. & 3 hours after IM ACTH stimulation and to find out glucocorticoid response in critically ill patients.

Materials and Methods

A descriptive study was designed in the Medical ICU of SCB Medical College, Cuttack, 46 critically ill adult patients with various diseases admitted to Medical ICU and were having or suspected of having some degree of adrenocortical dysfunction on the basis of prolonged hypotension for more than 6 hours despite adequate fluid challenge and/or need for vasopressors/inotropes, were included in this study for the period from Sep. 2013 to Sep. 2015.

Results

Out of total 46 ill patients, 25 patients were diagnosed as adrenal insufficiency. Amongst them, 14 were male and 11 were female. Most of them presented with various combinations of hypotension, fever, nausea, vomiting, fatigue, pigmentation, weakness and irritability.

Conclusion

We concluded that intramuscular Acton Prolongatum can be used for ACTH stimulation test in critically ill patients to diagnose adrenal insufficiency (AI).

KEYWORDS

Critically ill patient, Intensive care unit (ICU), Adrenal insufficiency, Acton Prolongatum, ACTH stimulation test.