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Several studies have suggested that some patients with severe sepsis have relative adrenal insufficiency (i.e., inadequate adrenal reserve), according to cosyntropin stimulation testing. However, this test assesses only the adrenal gland — not the entire hypothalamic-pituitary-adrenal (HPA) axis. In this study, French researchers used the overnight single-dose metyrapone test to assess the overall integrity of the HPA axis.
Metyrapone testing was performed for 101 intensive care unit patients with severe sepsis, 44 ICU patients without sepsis, and 32 healthy controls. Adrenal insufficiency was found in 60% of septic patients, 7% of nonseptic ICU patients, and no controls. Hypothalamic-pituitary dysfunction was responsible for three quarters …