Adrenal insufficiency in acute coronary syndrome

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Abstract

Introduction: Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date, no known study done to determine its prevalence in patients with ACS. Methods: 37 patients who fulfilled the diagnostic criteria of ACS were subjected to the low-dose (1 μg) ACTH stimulation test (LDT), followed by a standard-dose (250 μg) ACTH stimulation test (SDT) two hours later. Results: 14 (37.8 percent) patients had ST acute myocardial infarction, eight (21.6 percent) patients had non-ST elevation myocardial infarction, and 15 (40.5 percent) patients had unstable angina. Based on an increment of less than 250 nmol/L post-SDT, no patient had adrenal insufficiency. However, using a similar criteria with the LDT, eight (21.6 percent) patients had adrenal insufficiency. Four patients died during the study and they had very high cortisol levels. The diagnosis of adrenal insufficiency is not associated with any significant morbidity and mortality in our group of patients. Conclusion: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality.

Original languageEnglish
Pages (from-to)962-966
Number of pages5
JournalSingapore Medical Journal
Volume50
Issue number10
Publication statusPublished - Oct 2009

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Adrenal Insufficiency
Acute Coronary Syndrome
Morbidity
Adrenocorticotropic Hormone
Mortality
Unstable Angina
Critical Illness
Hypothalamus
Hydrocortisone
Myocardial Infarction

Keywords

  • ACTH stimulation test
  • Acute coronary syndrome
  • Adrenal insufficiency
  • Cortisol

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Adrenal insufficiency in acute coronary syndrome",
abstract = "Introduction: Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date, no known study done to determine its prevalence in patients with ACS. Methods: 37 patients who fulfilled the diagnostic criteria of ACS were subjected to the low-dose (1 μg) ACTH stimulation test (LDT), followed by a standard-dose (250 μg) ACTH stimulation test (SDT) two hours later. Results: 14 (37.8 percent) patients had ST acute myocardial infarction, eight (21.6 percent) patients had non-ST elevation myocardial infarction, and 15 (40.5 percent) patients had unstable angina. Based on an increment of less than 250 nmol/L post-SDT, no patient had adrenal insufficiency. However, using a similar criteria with the LDT, eight (21.6 percent) patients had adrenal insufficiency. Four patients died during the study and they had very high cortisol levels. The diagnosis of adrenal insufficiency is not associated with any significant morbidity and mortality in our group of patients. Conclusion: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality.",
keywords = "ACTH stimulation test, Acute coronary syndrome, Adrenal insufficiency, Cortisol",
author = "{A. Wahab @ A. Rahman}, Norasyikin and Norlela Sukor and Rozita Mohd and Masliza Mahmod and Shah, {Shamsul Azhar} and Kamaruddin, {Nor Azmi}",
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T1 - Adrenal insufficiency in acute coronary syndrome

AU - A. Wahab @ A. Rahman, Norasyikin

AU - Sukor, Norlela

AU - Mohd, Rozita

AU - Mahmod, Masliza

AU - Shah, Shamsul Azhar

AU - Kamaruddin, Nor Azmi

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N2 - Introduction: Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date, no known study done to determine its prevalence in patients with ACS. Methods: 37 patients who fulfilled the diagnostic criteria of ACS were subjected to the low-dose (1 μg) ACTH stimulation test (LDT), followed by a standard-dose (250 μg) ACTH stimulation test (SDT) two hours later. Results: 14 (37.8 percent) patients had ST acute myocardial infarction, eight (21.6 percent) patients had non-ST elevation myocardial infarction, and 15 (40.5 percent) patients had unstable angina. Based on an increment of less than 250 nmol/L post-SDT, no patient had adrenal insufficiency. However, using a similar criteria with the LDT, eight (21.6 percent) patients had adrenal insufficiency. Four patients died during the study and they had very high cortisol levels. The diagnosis of adrenal insufficiency is not associated with any significant morbidity and mortality in our group of patients. Conclusion: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality.

AB - Introduction: Acute coronary syndrome (ACS) is an acute stressful condition which stimulates the hypothalamus-pituitary-adrenal axis that regulates neurovascular and hormonal responses. Functional hypoadrenalism has been shown to be associated with significant morbidity and mortality in the critically-ill patient, but there is to date, no known study done to determine its prevalence in patients with ACS. Methods: 37 patients who fulfilled the diagnostic criteria of ACS were subjected to the low-dose (1 μg) ACTH stimulation test (LDT), followed by a standard-dose (250 μg) ACTH stimulation test (SDT) two hours later. Results: 14 (37.8 percent) patients had ST acute myocardial infarction, eight (21.6 percent) patients had non-ST elevation myocardial infarction, and 15 (40.5 percent) patients had unstable angina. Based on an increment of less than 250 nmol/L post-SDT, no patient had adrenal insufficiency. However, using a similar criteria with the LDT, eight (21.6 percent) patients had adrenal insufficiency. Four patients died during the study and they had very high cortisol levels. The diagnosis of adrenal insufficiency is not associated with any significant morbidity and mortality in our group of patients. Conclusion: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality.

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