Researchers Debunk Classic Myths of Condition Often Seen in Critical Patients

A study by researchers at the Paul L. Foster School of Medicine proves certain diagnostic markers do not predict relative adrenal insufficiency (RAI) in critically ill or injured patients.

RAI is a potentially life-threatening syndrome that results from inadequate basal or stress levels of plasma control, according to the U.S. National Library of Medicine. RAI is often under recognized and under diagnosed because current diagnostic tests are not sensitive enough to detect it.

Traditional teaching describes an association of hyponatremia (deficiency of sodium in body fluids), hyperkalemia (high levels of potassium in the blood), hypercalcemia (too much calcium in the blood), hypoglycemia (low blood sugar) and eosinophilia (high level of white blood cells) in patients with RAI.

“Relative Adrenal Insufficiency and the Critical Care Setting: Debunking the Classic Myth,” a research study conducted in the medical and surgical intensive care units of University Medical Center of El Paso, and led by Fatuma Kromah, M.D., contradicts the aforementioned theory. In fact, Kromah and his research team found that many patients with RAI who participated in the study had opposite results.

Kromah and his team also concluded that in the critical care setting, classic laboratory tests are of minimal value in predicting patients who may have RAI. Physicians treating patients with severe stress should instead obtain a random serum cortisol level to test for RAI.

“This study is a good example of opportunistic clinical research from colleagues making the extra effort while fully engaged in the setting of a very busy clinical environment,” said Richard McCallum, M.D., professor and chairman of the Department of Internal Medicine.

Researchers who assisted with the study include Alan Tyroch, M.D., and Susan McLean, M.D., in the Department of Surgery; Harold Hughes, M.D., and Nina Flavin, M.D., in the Department of Internal Medicine; and Soyoung Lee, MCIS, MCTS, an analyst in the Division of Biostatistics and Epidemiology.

Results of the study were recently published in the World Journal of Surgery.