Adrenal Insufficiency as a Possible Contributor to Pain in Adults With Sickle Cell Disease (SCD) (413-B)

Abstract

Result. Serum cortisol values were obtained on 61 occasions in 37 patients and one patient had a 24 hr urine cortisol determination. Adrenal insufficiency was present on 41 occasions overall (66%) including 28 events during 40 hospitalizations for VOC (70%) and 6 events during 22 outpatient visits (27%). Low serum cortisol values were present on at least 1 occasion in 24 of the 38 individuals (63%). When only morning cortisol values were considered (4 am-8 am), values were low in 13 of 20 determinations (65%) and were actually # 3 mcg/dl on 8 occasions (40%). Cosyntropin stimulation tests were performed in 16 patients with adrenal insufficiency and increases at 1 hr to $ 18 mcg/dl occurred on 10 occasions (63%). Increased eosinophil counts (> 500/mm) were present during 18 of 27 events when cortisol values were low (65%) but on only 6 of 20 occasions when cortisol values were normal (30%; x 1⁄4 6.1815; p < .02). Conclusion. Adrenal insufficiency is common in adult SCD patients, functionally significant and usually, but not always, due to impaired hypothalamic-pituitary function.