Abstract
Patients and Measurements: Baseline serum total cortisol, cosyntropin-stimulated serum total cortisol, aldosterone, and free cortisol concentrations were measured in 66 critically ill patients with an APACHE score of 15 or higher, 33 healthy volunteers, and 7 patients with adrenal insufficiency secondary to hypopituitarism. Patients were further divided into two groups based on their serum albumin concentrations of ≤ 2.5 g/dL (low albumin group, n=36) or >2.5 g/dL (normal albumin group, n=30).
Highlights
Because more than 90 percent of circulating cortisol in human serum is protein-bound, changes in binding proteins can alter measured serum total cortisol concentrations without influencing free concentrations of this hormone
Baseline and cosyntropin-stimulated serum total cortisol concentrations were significantly lower in the low albumin group than the normal albumin group
Measuring serum free cortisol concentrations in critically ill patients with hypoproteinemia may help prevent the unnecessary use of glucocorticoid therapy
Summary
Because more than 90 percent of circulating cortisol in human serum is protein-bound, changes in binding proteins can alter measured serum total cortisol concentrations without influencing free concentrations of this hormone. Patients with presumably normal adrenal function but decreased cortisol-binding proteins will have lower-thanexpected concentrations of serum total cortisol but appropriately elevated free cortisol levels. Measurement of serum free cortisol concentrations will identify patients with normal or even increased adrenal function, who, on the basis of low total cortisol concentrations, would otherwise have been incorrectly considered to have adrenal insufficiency
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