Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms

Manesh Parikshak, Alexander D. Shepard, Daniel J. Reddy, Timothy J. Nypaver, Gilbert Upchurch, Thomas Cogbill, Iraklis I Pipinos

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: Failure of the adrenocortical system after open repair of ruptured abdominal aortic aneurysm (RAAA) has never been reported, to our knowledge. This study was undertaken to examine the incidence and response to treatment of adrenal insufficiency in the RAAA population. Methods: A 6-year retrospective analysis was carried out on data for all patients admitted after RAAA repair. A cosyntropin stimulation test (CST) was performed in patients with unexplained postoperative hypotension. Patients with adrenal insufficiency were given stress dose hydrocortisone, followed by slow hydrocortisone taper. Results: Twenty of 26 patients admitted after RAAA repair survived longer than 1 week. Nine of these 20 patients underwent CST because of unexplained hypotension, and six patients were found to have adrenal insufficiency. Compared with the three patients with normal CST and the 11 patients with normotension who did not require testing, patients with adrenal insufficiency had greater preoperative hypotension (83% vs 29%; P = .05), greater operative blood loss (7.0 ± 1.6 L vs 3.0 ± 0.9 14 P = .003), longer lower extremity ischemia time (5.0 ± 2.3 hours vs 1.3 ± 0.5 hours; P = .025), and lower intraoperative urine output (0.8 ± 0.4 mL/kg/hr vs 2.1 ± 0.6 mL/kg/hr; P = .023). No difference in length of stay (40 ± 18 days vs 35 ± 26 days), major complications (27% vs 32%), or overall mortality (17% vs 15%) was demonstrated with steroid therapy. Initiation of steroid therapy enabled weaning of vasopressor support within 48 hours in patients with adrenal insufficiency. Conclusions: Adrenal insufficiency was identified in 67% of patients with RAAA with unexplained postoperative hypotension given a CST. Predictors of adrenal insufficiency after RAAA repair include preoperative hypotension and a complicated operative course. Steroid therapy can limit vasopressor dependence, and is not associated with increased morbidity or mortality.

Original languageEnglish (US)
Pages (from-to)944-950
Number of pages7
JournalJournal of Vascular Surgery
Volume39
Issue number5
DOIs
StatePublished - Jan 1 2004

Fingerprint

Aortic Rupture
Adrenal Insufficiency
Abdominal Aortic Aneurysm
Cosyntropin
Hypotension
Steroids
Hydrocortisone
Mortality
Therapeutics
Weaning
Lower Extremity
Length of Stay
Ischemia
Urine

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Parikshak, M., Shepard, A. D., Reddy, D. J., Nypaver, T. J., Upchurch, G., Cogbill, T., & Pipinos, I. I. (2004). Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms. Journal of Vascular Surgery, 39(5), 944-950. https://doi.org/10.1016/j.jvs.2004.01.020

Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms. / Parikshak, Manesh; Shepard, Alexander D.; Reddy, Daniel J.; Nypaver, Timothy J.; Upchurch, Gilbert; Cogbill, Thomas; Pipinos, Iraklis I.

In: Journal of Vascular Surgery, Vol. 39, No. 5, 01.01.2004, p. 944-950.

Research output: Contribution to journalArticle

Parikshak, M, Shepard, AD, Reddy, DJ, Nypaver, TJ, Upchurch, G, Cogbill, T & Pipinos, II 2004, 'Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms', Journal of Vascular Surgery, vol. 39, no. 5, pp. 944-950. https://doi.org/10.1016/j.jvs.2004.01.020
Parikshak M, Shepard AD, Reddy DJ, Nypaver TJ, Upchurch G, Cogbill T et al. Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms. Journal of Vascular Surgery. 2004 Jan 1;39(5):944-950. https://doi.org/10.1016/j.jvs.2004.01.020
Parikshak, Manesh ; Shepard, Alexander D. ; Reddy, Daniel J. ; Nypaver, Timothy J. ; Upchurch, Gilbert ; Cogbill, Thomas ; Pipinos, Iraklis I. / Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms. In: Journal of Vascular Surgery. 2004 ; Vol. 39, No. 5. pp. 944-950.
@article{687a116377564f83ab13d5320c5d3d9d,
title = "Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms",
abstract = "Purpose: Failure of the adrenocortical system after open repair of ruptured abdominal aortic aneurysm (RAAA) has never been reported, to our knowledge. This study was undertaken to examine the incidence and response to treatment of adrenal insufficiency in the RAAA population. Methods: A 6-year retrospective analysis was carried out on data for all patients admitted after RAAA repair. A cosyntropin stimulation test (CST) was performed in patients with unexplained postoperative hypotension. Patients with adrenal insufficiency were given stress dose hydrocortisone, followed by slow hydrocortisone taper. Results: Twenty of 26 patients admitted after RAAA repair survived longer than 1 week. Nine of these 20 patients underwent CST because of unexplained hypotension, and six patients were found to have adrenal insufficiency. Compared with the three patients with normal CST and the 11 patients with normotension who did not require testing, patients with adrenal insufficiency had greater preoperative hypotension (83{\%} vs 29{\%}; P = .05), greater operative blood loss (7.0 ± 1.6 L vs 3.0 ± 0.9 14 P = .003), longer lower extremity ischemia time (5.0 ± 2.3 hours vs 1.3 ± 0.5 hours; P = .025), and lower intraoperative urine output (0.8 ± 0.4 mL/kg/hr vs 2.1 ± 0.6 mL/kg/hr; P = .023). No difference in length of stay (40 ± 18 days vs 35 ± 26 days), major complications (27{\%} vs 32{\%}), or overall mortality (17{\%} vs 15{\%}) was demonstrated with steroid therapy. Initiation of steroid therapy enabled weaning of vasopressor support within 48 hours in patients with adrenal insufficiency. Conclusions: Adrenal insufficiency was identified in 67{\%} of patients with RAAA with unexplained postoperative hypotension given a CST. Predictors of adrenal insufficiency after RAAA repair include preoperative hypotension and a complicated operative course. Steroid therapy can limit vasopressor dependence, and is not associated with increased morbidity or mortality.",
author = "Manesh Parikshak and Shepard, {Alexander D.} and Reddy, {Daniel J.} and Nypaver, {Timothy J.} and Gilbert Upchurch and Thomas Cogbill and Pipinos, {Iraklis I}",
year = "2004",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2004.01.020",
language = "English (US)",
volume = "39",
pages = "944--950",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms

AU - Parikshak, Manesh

AU - Shepard, Alexander D.

AU - Reddy, Daniel J.

AU - Nypaver, Timothy J.

AU - Upchurch, Gilbert

AU - Cogbill, Thomas

AU - Pipinos, Iraklis I

PY - 2004/1/1

Y1 - 2004/1/1

N2 - Purpose: Failure of the adrenocortical system after open repair of ruptured abdominal aortic aneurysm (RAAA) has never been reported, to our knowledge. This study was undertaken to examine the incidence and response to treatment of adrenal insufficiency in the RAAA population. Methods: A 6-year retrospective analysis was carried out on data for all patients admitted after RAAA repair. A cosyntropin stimulation test (CST) was performed in patients with unexplained postoperative hypotension. Patients with adrenal insufficiency were given stress dose hydrocortisone, followed by slow hydrocortisone taper. Results: Twenty of 26 patients admitted after RAAA repair survived longer than 1 week. Nine of these 20 patients underwent CST because of unexplained hypotension, and six patients were found to have adrenal insufficiency. Compared with the three patients with normal CST and the 11 patients with normotension who did not require testing, patients with adrenal insufficiency had greater preoperative hypotension (83% vs 29%; P = .05), greater operative blood loss (7.0 ± 1.6 L vs 3.0 ± 0.9 14 P = .003), longer lower extremity ischemia time (5.0 ± 2.3 hours vs 1.3 ± 0.5 hours; P = .025), and lower intraoperative urine output (0.8 ± 0.4 mL/kg/hr vs 2.1 ± 0.6 mL/kg/hr; P = .023). No difference in length of stay (40 ± 18 days vs 35 ± 26 days), major complications (27% vs 32%), or overall mortality (17% vs 15%) was demonstrated with steroid therapy. Initiation of steroid therapy enabled weaning of vasopressor support within 48 hours in patients with adrenal insufficiency. Conclusions: Adrenal insufficiency was identified in 67% of patients with RAAA with unexplained postoperative hypotension given a CST. Predictors of adrenal insufficiency after RAAA repair include preoperative hypotension and a complicated operative course. Steroid therapy can limit vasopressor dependence, and is not associated with increased morbidity or mortality.

AB - Purpose: Failure of the adrenocortical system after open repair of ruptured abdominal aortic aneurysm (RAAA) has never been reported, to our knowledge. This study was undertaken to examine the incidence and response to treatment of adrenal insufficiency in the RAAA population. Methods: A 6-year retrospective analysis was carried out on data for all patients admitted after RAAA repair. A cosyntropin stimulation test (CST) was performed in patients with unexplained postoperative hypotension. Patients with adrenal insufficiency were given stress dose hydrocortisone, followed by slow hydrocortisone taper. Results: Twenty of 26 patients admitted after RAAA repair survived longer than 1 week. Nine of these 20 patients underwent CST because of unexplained hypotension, and six patients were found to have adrenal insufficiency. Compared with the three patients with normal CST and the 11 patients with normotension who did not require testing, patients with adrenal insufficiency had greater preoperative hypotension (83% vs 29%; P = .05), greater operative blood loss (7.0 ± 1.6 L vs 3.0 ± 0.9 14 P = .003), longer lower extremity ischemia time (5.0 ± 2.3 hours vs 1.3 ± 0.5 hours; P = .025), and lower intraoperative urine output (0.8 ± 0.4 mL/kg/hr vs 2.1 ± 0.6 mL/kg/hr; P = .023). No difference in length of stay (40 ± 18 days vs 35 ± 26 days), major complications (27% vs 32%), or overall mortality (17% vs 15%) was demonstrated with steroid therapy. Initiation of steroid therapy enabled weaning of vasopressor support within 48 hours in patients with adrenal insufficiency. Conclusions: Adrenal insufficiency was identified in 67% of patients with RAAA with unexplained postoperative hypotension given a CST. Predictors of adrenal insufficiency after RAAA repair include preoperative hypotension and a complicated operative course. Steroid therapy can limit vasopressor dependence, and is not associated with increased morbidity or mortality.

UR - http://www.scopus.com/inward/record.url?scp=2342453230&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342453230&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2004.01.020

DO - 10.1016/j.jvs.2004.01.020

M3 - Article

VL - 39

SP - 944

EP - 950

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 5

ER -