Evaluation of Adrenal Function in Chronic Obstructive Pulmonary Disease Patients Receiving Invasive and Noninvasive Mechanical Ventilation

Stress and severe disease states in the intensive care unit (ICU) cause release of adrenocorticoid hormone from the hypophysis and cortisol from the adrenal cortex by activating hypothalamo-pituitary adrenal axis. While adrenal insuffi ciency (AI) is seen in less than 0.01% of the normal population, its frequency is over 28% of cases in intensive care units (ICU). The aim of this study was to evaluate adrenal function in 36 cases with COPD, in pulmonary diseases ICU, receiving invasive mechanical ventilation (IMV) (n: 23) and noninvasive mechanical ventilation (NIMV) (n: 13). For this purpose, after obtaining a blood sample for baseline cortisol level, 1mg ACTH was given to patients in the fi rst day of admission to ICU. Cortisol levels were checked at the 30th and 60th minutes of ACTH test. Of all cases, mean age was 67.3 +/- 9.2, duration of hospitalization 12.9 +/- 9.3 days, APACHE II score 20.9 +/- 5.4, systolic blood pressure (bp) 103.5 +/- 28.2 mmHg, diastolic bp 64.6 +/- 19.2, mean arterial blood pressure 81.5 +/- 20.5 mmHg, sodium 138.3 +/- 6.3, potassium 4.3 +/- 1.2, urea 83.8 +/- 62.5 and creatinine was1.38 +/- 0.9 respectively. According to baseline cortisol levels, AI was present in 22 (45%) patients. Of these cases, 11 were in NIMV and 11 in IMV groups. When the baseline, 30th minute and 60th minute cortisol levels were compared, a statistically signifi cant difference was present (p< 0.05, for all). In conclusion, we consider that adrenal insuffi ciency is encountered frequently in COPD patients with respiratory failure and further studies are needed tobetter delineate this association.