Secondary adrenal failure due to sepsis
Atif Munir, Sath Nag & Rudy Bilous
Introduction: Hypothalamicpituitary adrenal axis dysfunction is common in severely ill patients. Even slight impairment of adrenal response to severe illness can increase morbidity and mortality. Relative adrenal insufficiency has been associated with severe sepsis.
Case report: We report a case of 48-year-old lady who was admitted with septic shock secondary to epiglottitis requiring intubation and intensive care. Short synacthen test performed in view of her refractory hypotension confirmed adrenal insufficiency. Her concurrent ACTH level was suppressed which suggested possible secondary adrenal insufficiency. Patient made an uneventful recovery with hydrocortisone treatment. She was investigated further to assess her pituitary function and structure. Anterior pituitary hormonal profile and MRI scan of pituitary fossa were normal. Adrenal auto antibodies were not detected. Long synacthen test performed ten months later revealed a flat cortisol profile with an increment after 24 h consistent with persistent secondary adrenal insufficiency hence steroid replacement was continued.
Conclusion: A high index of suspicion for adrenal insufficiency is required in all critically ill patients with refractory hypotension.