Assessment of knowledge, attitudes and practices about adrenal insufficiency in the critically ill among endocrinologists and intensivists practicing in Chennai
V. Gopichandran, A. Sathya, B. Srinivasan, G. Parasuraman, L. Ravikumar, S. Mahadevan, U. Sriram
Adrenal insufficiency, critically ill, KAP
Citation Information :
Gopichandran V, Sathya A, Srinivasan B, Parasuraman G, Ravikumar L, Mahadevan S, Sriram U. Assessment of knowledge, attitudes and practices about adrenal insufficiency in the critically ill among endocrinologists and intensivists practicing in Chennai. Indian J Crit Care Med 2006; 10 (3):176-180.
Background: Adrenal insufficiency is a common occurrence in the critically ill and it is essential that intensivists and endocrinologists involved in the care of these patients have a good understanding of the concepts related to this condition. Objectives: To assess the knowledge, attitudes and practices about adrenal insufficiency in the critically ill among the endocrinologists and intensivists practicing in the city of Chennai. Materials and Methods: Questionnaires containing ten questions pertaining to adrenal insufficiency in the critically ill were sent to a total of six endocrinologists and 52 intensivists practicing in Chennai. Results: About 77% of all the respondents agreed to the fact that adrenal insufficiency is a frequent occurrence in critical illness. But 57% of them felt that there is no need for routine evaluation of critically ill patients for adrenal insufficiency. Random serum cortisol was selected by 62% of the responders as the method for evaluating adrenal function in the critically ill. There is clearly no agreement among the endocrinologists or the intensivists on the various cut off levels for diagnosis. Neither is there a clear consensus on the method followed for treatment of patients with adrenal insufficiency in the critical care unit. Conclusion: There is no concordance in the knowledge, attitudes or practices on adrenal insufficiency in the critically ill among the endocrinologists and intensivists in Chennai. There is a need for developing standard diagnostic and treatment guidelines and making it available for all the practicing endocrinologists and intensivists.
Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. New Engl J Med 2003;348:727-34.
Lamberts SW, Bruining HA, de Jong FH. Corticosteroid therapy in severe illness. N Engl J Med 1997;337:1285-92.
Burchard K. A review of the adrenal cortex and severe inflammation: Quest of the “Eucorticoid” state. J Trauma 2001;51:800-14.
Sibbald WJ, Short A, Cohen MP, Wilson RF. Variations in adrenocortical responsiveness during severe bacterial infections: Unrecognized adrenocortical insufficiency in severe bacterial infections. Ann Surg 1977;186:29-33.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic hock based on cortisol levels and cortisol response to corticotropin. JAMA 2000;283:1038-45.
Barquist E, Kirton O. Adrenal insufficiency in the surgical intensive care unit patient. J Trauma 1997;42:27-31.
Kidess AI, Caplan RH, Reynertson RH, Wickus GG, Goodnough DE. Transient corticotropin deficiency in critical illness. Mayo Clin Proc 1993;68:435-41.
Bouachour G, Tirot P, Varache N, Govello JP, Harry P, Alquier P. Hemodynamic changes in acute adrenal insufficiency. Intensive Care Med 1994;20:138-41.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E. A 3 level prognostic classification in Septic Shock based on Cortisol levels and Cortisol response to Corticotropin. JAMA 2000;283:1038-45.
Streeten DH. What test for hypothalamic-pituitary adrenocortical insufficiency? Lancet 1999;354:179-80.
Abdu TA, Elhadd TA, Neary R, Clayton RN. Comparison of the low dose short Synacthen test (1 microg), the conventional dose short Synacthen test (250 microg) and insulin tolerance test for assessment of the hypopthalamo-pituitary-adrenal axis in patients with pituitary disease. J Clin Endocrinol Metab 1999;84:838-43.
McKee JI, Finlay WI. Cortisol replacement in the severely stressed patients (Letter). Lancet 1983;1:484.
Bollaret PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiological doses of hydrocortisone. Crit Care Med 1998;26:645-50.
Briegel J, Frost J, Haller M, Schelling G, Kilger E, Kuprat G, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double blind, single center study. Crit Care Med 1999;27:723-32.
Annane D. Effects of the combination of hydrocortisone and fluodrocortisone on mortality in septic shock. Crit Care Med 2000;28:A46.
Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for severe sepsis and septic shock: A systematic review and meta-analysis. BMJ 2004;329:480.