Cardiac/Hemodynamics/Monitoring Adrenal insufficiency in cardiothoracic patients: An evaluation of the corticotrophin stimulation test and other diagnostic methods ☆,☆☆,★,★★ Evert A. Eriksson MD a, ⁎ , Charles L. Willekes MD, FACS b , Karen J. McAllen PharmD c , Oreste M. Romeo MD d , Robert L. Hooker MD, FACS b , James E. Hoogeboom DO, FCCM, FACOS e , Jeffrey F. Barletta PharmD, FCCM f a Medical University of South Carolina, Department of Trauma and General Surgery, Charleston, SC 29425, USA b West Michigan Cardiothoracic Surgery, Grand Rapids, MI 49503, USA c Adult Critical Care, Department of Pharmacy Services, Spectrum Health, Grand Rapids, MI 49503, USA d Hancock Regional Hospital, General Surgery Department, Greenfield, IN 46140, USA e Division of Surgical Critical Care, Spectrum Health, Grand Rapids, MI 49503, USA f Department of Pharmacy Practice, Midwestern University, College of Pharmacy—Glendale, Glendale, AZ 85308, USA Keywords: Adrenal insufficiency; Corticotropin; Cardiothoracic surgery Abstract Purpose: The purposes of the study were to determine the incidence of adrenal insufficiency (AI) using several published techniques, compare the response rates using a low-dose (LD) corticotropin (ACTH) stimulation test vs a standard dose (SD), and identify the technique that is most closely related to vasopressor use. Materials and Methods: Consecutive adult patients who were undergoing open heart surgery for CAD or valvular disease were prospectively enrolled. Exclusion criteria included history of steroid use, operative steroid, or etomidate administration. Postoperatively, each patient underwent ACTH stimulation with 1 μg (LD) and 249 μg (SD), 60 minutes apart. Agreement among the tests was evaluated, and vasopressor use was compared between groups. Results: There were 40 patients evaluated. The incidence of AI based on operative change, postoperative values, and LD-ACTH and SD-ACTH tests was 53%, 38%, 60%, and 38%, respectively. Agreement between the LD- and SD-ACTH tests was 73% (κ = 0.476, P = .001). There was a ☆ Poster Presentation at Society of Critical Care Medicine Clinical Congress Honolulu, Hawaii, February 2008. ☆☆ Funding: Provided by a grant from the Spectrum Health Foundation and the foundation was not involved in collecting data or interpretation of results in any way. ★ This research project was completed at Spectrum Health in Grand Rapids, MI. ★★ Conflicts: None. ⁎ Corresponding author. Evert A. Eriksson, MD, Assistant Professor of Surgery, Medical University of South Carolina, Department of Trauma and General Surgery, 96 Jonathan Lucas Street, CSB 420, Charleston, SC 29425, USA. Tel.: +1 843 792 3780; fax: +1 843 792 1798. E-mail addresses: evsurgery@gmail.com (E.A. Eriksson), willekes@wmcts.com (C.L. Willekes), karen.mcallen@spectrum-health.org (K.J. McAllen), oresteromeo@sbcglobal.net (O.M. Romeo), Hooker@wmcts.com (R.L. Hooker), James.hoogeboom@spectrum-health.org (J.E. Hoogeboom), jbarle@midwestern.edu (J.F. Barletta). 0883-9441/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcrc.2011.12.014 Journal of Critical Care (2012) 27, 528.e1–528.e6