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DOI: 10.1055/s-2007-980200
© Georg Thieme Verlag KG Stuttgart · New York
Value of Free Cortisol Measurement in Systemic Infection
Publikationsverlauf
received 20. 10. 2006
accepted 21. 12. 2006
Publikationsdatum:
18. Juni 2007 (online)
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Abstract
Systemic infection induces an increase in plasma cortisol which accords approximately with illness severity. However, both basal and synthetic ACTH stimulated cortisol levels are not strong predictors of mortality. Moreover, plasma cortisol levels do not readily define those patients who have been clinically observed to respond, with respect to blood pressure elevation, to exogenous hydrocortisone. It is likely that free cortisol, accounting for 6-20% of circulating total (bound plus free) cortisol has most of the life-saving effects on circulation and metabolism in severe sepsis, as corticosteroid-binding globulin bound and albumin-bound cortisol have reduced access to tissues. In addition, sepsis reduces CBG and albumin levels, hence blunting the effect of increasing illness severity on total cortisol. Our recent studies suggest that free cortisol correlates more closely to sepsis severity than total cortisol and that free cortisol levels can be estimated using the plasma CBG and total cortisol, obviating the need for direct free cortisol measurement. Studies directed at determining if free cortisol is a better guide than total cortisol to the need for hydrocortisone supplementation may be of value.
Key words
Free cortisol - septic shock - relative adrenal insufficiency (RAI)
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Correspondence
Dr. D. Torpy
Endocrine and Metabolic Unit
Royal Adelaide Hospital
Adelaide 5000
South Australia
Australia
Telefon: +61/8/8222 55 20
Fax: +61/8/8222 59 08
eMail: dtorpy@mail.rah.sa.gov.au