Upon-admission adrenal steroidogenesis is adapted to the degree of illness in intensive care unit patients.

Adrenal function was studied in 2 groups of intensive care unit (ICU) patients with varying degrees of illness, as determined by Acute Physiological and Chronic Health Evaluation (APACHE). The 15 seriously ill patients with high APACHE scores (greater than or equal to 25) had elevated Therapeutic Intervention Scores and increased mortality compared to the 15 ill patients (APACHE, less than or equal to 10; 67% vs. 27%).

Spectrum of serum cortisol response to ACTH in ICU patients. Correlation with degree of illness and mortality.

Recent reports suggest adrenal insufficiency in critically ill patients is common. We found only one case of de novo adrenal insufficiency using admission ACTH injection in 70 selected intensive care unit (ICU) patients. Random serum cortisol levels correlated positively with illness severity in ICU patients using proven methods for assessing illness severity.

Thyrotropin-releasing hormone tests in an outpatient clinic.

Measurement of thyroid-stimulating hormone (TSH) levels in various timed blood samples after administration of thyrotropin-releasing hormone (TRH) has become a standard part of the diagnostic armamentarium for suspected thyroid disease. We reviewed the records of 165 patients who received TRH tests in an endocrinology outpatient clinic to assess the diagnostic utility of the test based upon other clinical parameters, and to assess concordance of the 30-minute TSH value after intravenous administration of TRH. Standard (control) values for TRH testing were obtained in 41 normal subjects.

Hypercalcemia in a patient with eosinophilic granuloma.

Persistent hypercalcemia subsequently developed in a 46-year-old black woman with biopsy-proved eosinophilic granuloma. Evaluation of this patient excluded or made highly unlikely any of the known causes of hypercalcemia. As with several other granulomatous diseases, eosinophilic granuloma is likely an occasional cause of hypercalcemia.