Serum cortisol binding capacity measured with concanavalin A-sepharose in patients with a recent inflammatory response

Abstract

It has been suggested that elastase released from activated neutrophils degrades cortisol binding globulin. A novel assay for serum cortisol binding capacity was therefore devised and applied to assess whether such degradation was evident in patients showing a recent inflammatory response as indicated by a raised serum C-reactive protein. In 49 patients with evidence (C-reactive protein > 50 mg/l) of a recent inflammatory response, mean serum cortisol binding capacity (288 nmol/l, S.D. = 82.9) was significantly lower ( P < 0.05, t test) than in 48 patients (320 ± 75.8 nmol/l) whose responses was quiescent (C-reactive protein < 6 mg/l) or in 49 healthy controls (335 ± 72.4 nmol/l). Four patients with septic shock had markedly reduced values (167 ± 49.9 nmol/l) but low values were not restricted to this condition. It is concluded that a population experiencing a recent inflammatory response exhibits reduced serum cortisol binding capacity but a role for elastase in this process remains to be defined.