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NESS 2006 Annual Meeting
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Relative Adrenal Insufficiency in the Adult Burn Intensive Care Unit
Jeremy Goverman1, Manuel Garcia-Toca1, Colleen M Ryan2
1Massachusetts General Hospital, Boston, MA;2Massachusetts General Hospital, Harvard Medical School, Boston, MA

Objective: This study describes the diagnosis and treatment of relative adrenal insufficiency in four burn intensive care unit (BICU) patients.
Design: Retrospective Case Series
Setting: One American Burn Association verified Adult Burn Intensive Care Unit at an Academic Medical Center.
Patients: A centralized clinical data registry was used to identify patients. We searched adult burn patients admitted to the Burn Service between Jan 1,2000 and Jan 1, 2005 for those patients requiring treatment with steroids for adrenal insufficiency diagnosed using the corticotropin (ACTH) stimulation test.
Main Outcome Measures: The hospital course of burn patients with relative adrenal insufficiency is described. Reasons for adrenal work-up, baseline cortisol, response to cosyntropin stimulation test, pressor requirements before and after initiation of steroid replacement, and outcome were evaluated.
Results: Four patients were identifed as adrenally insufficient and were treated with intravenous steroid replacement therapy. In all but one case, vasopressor requirements decreased after initiation of treatment and all but one patient survived.
Conclusions: Current recommendations with respect to steroid replacement in septic, hemodynamically unstable, critically ill patients should apply to the burn patient as well. The role of the corticotropin stimulation test in the diagnosis of adrenal insufficiency still needs further refinement.

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