Cortisol Response in Relation to the Severity of Stress and Illness

• Published in: The journal of clinical endocrinology and metabolism 2005-08, Vol.90 (8), p.4579-4586
• Main Authors: Widmer, Isabelle E., Puder, Jardena J., König, Caroline, Pargger, Hans, Zerkowski, Hans Reinhard, Girard, Jürg, Müller, Beat
• Format: Article
• Language: English
• Subjects: Adaptation, Physiological; Adrenocorticotropic Hormone - administration & dosage; Adrenocorticotropic Hormone - blood; Adult; Aged; Biological and medical sciences; Coronary Artery Bypass; Coronary Artery Disease - blood; Coronary Artery Disease - surgery; Diagnostic Techniques, Endocrine - standards; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Humans; Hydrocortisone - blood; Hypothalamo-Hypophyseal System - physiology; Male; Medical sciences; Middle Aged; Pituitary-Adrenal System - physiology; Reproducibility of Results; Severity of Illness Index; Stress, Physiological - blood; Stress, Physiological - diagnosis; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2005-0354

Background: The aim of the study was to compare the adrenal response, the course of the ACTH/cortisol ratio, as well as the variance and the diagnostic performance of different cutoffs after 1 and 250 μg ACTH stimulation in different stress situations. Methods: We investigated three groups with increasing stress levels: ambulatory controls (group A; n = 20), hospitalized medical patients (group B; n = 25), and patients undergoing coronary artery bypass grafting (group C; n = 29). All subjects underwent four consecutive ACTH stimulation tests and were randomized to either a 1- or 250-μg dose. Results: Stimulated cortisol levels in group A were similar to basal cortisol levels under maximal stress (C3; P = 0.8). Peak cortisol concentrations were higher after 250 μg compared with 1 μg ACTH in group B (P = 0.006) and under maximal stress after extubation (group C3; P = 0.027), whereas there were no differences in group A. The ACTH/cortisol ratio was lower in surgical patients after extubation compared with unstressed conditions (P ≤ 0.03) The within-subject variance was similar in ambulatory controls and medical patients and after both ACTH doses (all 17–36% of total variance). Cutoff dependent, the diagnosis of relative adrenal insufficiency would have been made in 0–58.3%, respectively. Conclusion: In moderate and major stress situations, cortisol concentrations in patients without hypothalamic-pituitary-adrenal disease were higher after stimulation with 250 μg compared with 1 μg ACTH. Data from our study give insight into the physiological adaptations of the hypothalamic-pituitary-adrenal axis to stress.