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01-12-2003 | Original

HDL-cholesterol level and cortisol response to synacthen in critically ill patients

Authors: Peter H. J. van der Voort, Rik T. Gerritsen, Andries J. Bakker, E. Christiaan Boerma, Michael A. Kuiper, Loek de Heide

Published in: Intensive Care Medicine | Issue 12/2003

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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Title: HDL-cholesterol level and cortisol response to synacthen in critically ill patients
Authors: Peter H. J. van der Voort
Rik T. Gerritsen
Andries J. Bakker
E. Christiaan Boerma
Michael A. Kuiper
Loek de Heide
Publication date: 01-12-2003
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2021-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

HDL-cholesterol level and cortisol response to synacthen in critically ill patients

Abstract

Objective

Design

Patients

Measurements

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Patients

Measurements

Results

Conclusions

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