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Steroidogenesis in the adrenal dysfunction of critical illness: impact of etomidate

Overview of attention for article published in Critical Care, July 2012
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Title
Steroidogenesis in the adrenal dysfunction of critical illness: impact of etomidate
Published in
Critical Care, July 2012
DOI 10.1186/cc11415
Pubmed ID
Authors

Nienke Molenaar, Ronald M Bijkerk, Albertus Beishuizen, Christel M Hempen, Margriet FC de Jong, Istvan Vermes, Gertjan van der Sluijs Veer, Armand RJ Girbes, AB Johan Groeneveld

Abstract

ABSTRACT: INTRODUCTION: This study was aimed at characterizing basal and adrenocorticotropic hormone (ACTH)-induced steroidogenesis in sepsis and nonsepsis patients with a suspicion of critical illness-related corticosteroid insufficiency (CIRCI), taking the use of etomidate-inhibiting 11β-hydroxylase into account. METHOD: This was a prospective study in a mixed surgical/medical intensive care unit (ICU) of a university hospital. The patients were 62 critically ill patients with a clinical suspicion of CIRCI. The patients underwent a 250-μg ACTH test (n = 67). ACTH, adrenal steroids, substrates, and precursors (modified tandem mass spectrometry) also were measured. Clinical characteristics including use of etomidate to facilitate intubation (n = 14 within 72 hours of ACTH testing) were recorded. RESULTS: At the time of ACTH testing, patients had septic (n = 43) or nonseptic critical illness (n = 24). Baseline cortisol directly related to sepsis and endogenous ACTH, independent of etomidate use. Etomidate was associated with a lower baseline cortisol and cortisol/11β-deoxycortisol ratio as well as higher 11β-deoxycortisol, reflecting greater 11β-hydroxylase inhibition in nonsepsis than in sepsis. Cortisol increases < 250 mM in exogenous ACTH were associated with relatively low baseline (HDL-) cholesterol, and high endogenous ACTH with low cortisol/ACTH ratio, independent of etomidate. Although cortisol increases with exogenous ACTH, levels were lower in sepsis than in nonsepsis patients, and etomidate was associated with diminished increases in cortisol with exogenous ACTH, so that its use increased, albeit nonsignificantly, low cortisol increases to exogenous ACTH from 38% to 57%, in both conditions. CONCLUSIONS: A single dose of etomidate may attenuate stimulated more than basal cortisol synthesis. However, it may only partly contribute, particularly in the stressed sepsis patient, to the adrenal dysfunction of CIRCI, in addition to substrate deficiency.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 96 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 1%
United States 1 1%
South Africa 1 1%
Brazil 1 1%
Unknown 92 96%

Demographic breakdown

Readers by professional status Count As %
Student > Master 17 18%
Student > Bachelor 11 11%
Other 9 9%
Researcher 8 8%
Student > Postgraduate 7 7%
Other 27 28%
Unknown 17 18%
Readers by discipline Count As %
Medicine and Dentistry 54 56%
Nursing and Health Professions 8 8%
Agricultural and Biological Sciences 4 4%
Pharmacology, Toxicology and Pharmaceutical Science 3 3%
Biochemistry, Genetics and Molecular Biology 2 2%
Other 7 7%
Unknown 18 19%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 July 2012.
All research outputs
#20,674,485
of 25,394,764 outputs
Outputs from Critical Care
#5,972
of 6,558 outputs
Outputs of similar age
#139,526
of 178,047 outputs
Outputs of similar age from Critical Care
#95
of 119 outputs
Altmetric has tracked 25,394,764 research outputs across all sources so far. This one is in the 10th percentile – i.e., 10% of other outputs scored the same or lower than it.
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We're also able to compare this research output to 119 others from the same source and published within six weeks on either side of this one. This one is in the 3rd percentile – i.e., 3% of its contemporaries scored the same or lower than it.