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Adrenal Insufficiency with somewhat normal cortisol stimulation test
by quincyrn, Oct 27, 2009 11:49PM
My husband fell and suffered a c spine fracture 5 weeks ago. He had surgery immediately, but about 10 days after surgery had massive pulmonary complications and was in a medically induced coma for 2 weeks. He suffered from fever and infections almost immediately. I recently discovered he had been using steroids for a long period of time, so that was abruptly stopped. He has cultured positive for yeast multiple times and other gram positive and negative bacteria. All STD tests were done and negative. He keeps getting sicker with spiking fevers, excessive edema, boarderline low bp requiring vasopressin at times, yet his WBC is only 5.5. His H/H are hovering at 21 and 6.6. I suspect adrenal insufficiency yet a cortisol stimulation test done this evening was 25 initially, then 7, then 35??? The ICU is treating him with steroids. The doctors are stumpted at his immunosupression and fever? I think AI explains all. Any other opinions
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If his cortisol doesn't double at 60' (looks like his didn't), he has AI. Adrenal crisis can involve high spiking fevers - the Merck professional manual lists this as a symptom (you can google this). High sudden fevers were always a part of my symptom set prior to treatment. I have PAI. I agree with you, that (from what I've read) AI would explain everything that's going on with him, in which case steroids are what he needs as long as they are dosed properly. Most professional manuals suggest 100mgs/Hydrocortisone (or equivalent in other steroid, but HC is preferred b/c it also has mineralocorticoid properties) every 6 hours until the patient is stable and can take oral meds. How are his electrolytes? Secondary AI, from long-term steroid use, shouldn't affect his Na/K as much as PAI would, but it's still a consideration esp. if his BP continues to drop...
Feel free to send me a PM if you want to. I'm really sorry to hear about what's going on and hope he's pulling through by now.
Take care,
Leigh