OBJECTIVE: To explore adrenal function in severe West Nile virus (WNV) infection. DESIGN AND SETTING: Prospective interventional cohort study in a medical ICU of a teaching hospital. PATIENTS: Ten consecutive patients (seven men, mean age 64+/-12years, mean SAPS II 26+/-6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39+/-1 degrees C) and altered mental status (mean Glasgow Coma Score 11+/-2). Mean SOFA score was 9+/-2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation. INTERVENTIONS: A short corticotropin test was performed in each patient to assess the adrenal function. MEASUREMENTS AND RESULTS: Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 microg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 microg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 microg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived. CONCLUSION: Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.
OBJECTIVE: To explore adrenal function in severe West Nile virus (WNV) infection. DESIGN AND SETTING: Prospective interventional cohort study in a medical ICU of a teaching hospital. PATIENTS: Ten consecutive patients (seven men, mean age 64+/-12years, mean SAPS II 26+/-6) with definite diagnosis of WNV related meningoencephalitis and variable proportion of organ/system failure. All patients had fever (mean body temperature 39+/-1 degrees C) and altered mental status (mean Glasgow Coma Score 11+/-2). Mean SOFA score was 9+/-2; eight patients had systemic inflammatory response syndrome, five septic shock, and six acute respiratory failure (usually from central origin) requiring mechanical ventilation. INTERVENTIONS: A short corticotropin test was performed in each patient to assess the adrenal function. MEASUREMENTS AND RESULTS:Cortisol response was defined as the difference between baseline and corticotropin-stimulated peak. Absolute adrenal insufficiency was defined by a baseline cortisol level below 15 microg/dl (415 nmol/l). Relative insufficiency was defined by a cortisol response of 9 microg/dl (250 nmol/l) or less. Relative adrenal insufficiency, defined by a corticotropin response below 9 microg/dl, was observed in seven while the remaining three had normal cortisol response; six out of these seven died in the ICU. All patients with normal adrenal function survived. CONCLUSION:Adrenal insufficiency is frequent in severe WNV infection and carries a poor outcome. In the absence of specific effective treatment, our data provide a rational to investigate a supplemental corticosteroid treatment in a controlled trial.
Authors: J T Ho; H Al-Musalhi; M J Chapman; T Quach; P D Thomas; C J Bagley; J G Lewis; D J Torpy Journal: J Clin Endocrinol Metab Date: 2005-11-01 Impact factor: 5.958
Authors: A Takasawa; I Morimoto; A Wake; J Haratake; K Fujii; Y Okada; S Oda; H Hashimoto; S Eto Journal: Intern Med Date: 1995-06 Impact factor: 1.271
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