Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Free cortisol levels should not be used to determine adrenal responsiveness. | Available online at http content 9 1 E2 University of Pittsburgh Department of Critical Care Medicine Evidence-Based Medicine Journal Club EBM Journal Club Section Editor Eric B. Milbrandt MD MPH Journal club critique Free cortisol levels should not be used to determine adrenal responsiveness Aditya Dubey1 and Arthur J. Boujoukos2 1 Clinical Fellow Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA 2 Associate Professor Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA Published online 13 December 2004 This article is online at http content 9 1 E2 2004 BioMed Central Ltd Critical Care 2004 9 E2 DOI cc3040 Expanded Abstract Citation Hamrahian AH Oseni TS Arafah BM Measurements of serum free cortisol in critically ill patients. NEJM 2004 350 Background 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. Hypotheses Patients with presumably normal adrenal function but decreased cortisol-binding proteins will have lower-than-expected 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. Methods Setting Medical surgical and cardiac ICUs and general medical ward of a tertiary care . academic medical center. 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 .
