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DRUG INFORMATION ROUNDS

Interaction Between Dexamethasone Treatment and the Corticotropin Stimulation Test in Septic Shock

Critical Care Pharmacy Resident, College of Medicine and Department of Hospital Pharmacy Services, Mayo Clinic, Rochester, MN

Lance J Oyen, PharmD BCPS

Critical Care/Surgery Pharmacotherapy Coordinator and Assistant Professor of Pharmacy, College of Medicine and Department of Hospital Pharmacy Services, Mayo Clinic

Reprints: Dr. Oyen, 1216 Second St. SW, Rochester, MN 55902-1906, fax 507/255-7556, oyen.lance{at}mayo.edu

OBJECTIVE: To review dexamethasone interaction with corticotropin stimulation testing, particularly as it applies to treating septic shock.

DATA SOURCES: Pertinent literature was identified through MEDLINE (1966-February 2004) using combinations of the key words dexamethasone, adrenocorticotropic hormone stimulation, and pretreat. Only articles written in the English language and evaluating human subjects were considered. Reference lists of identified articles were reviewed for additional citations.

DATA SYNTHESIS: Accurate interpretation of the corticotropin stimulation test is important to identify patients with septic shock who may benefit from corticosteroid supplementation. In healthy volunteers, short-term dexamethasone administration prior to the corticotropin stimulation test may depress the baseline cortisol level, but does not inhibit the response to the corticotropin challenge. This may result in a slight increase in the difference between baseline and post-stimulation values.

CONCLUSIONS: In 2 small trials in healthy adults, short-term, low-dose dexamethasone pretreatment decreased baseline cortisol levels, but values following corticotropin stimulation were unaffected. Accordingly, caution in interpreting corticotropin stimulation test results is warranted. However, the application of the findings from these studies to patients with septic shock is difficult, given the important differences in physiology between normal and septic patients. As of December 29, 2004, a dexamethasone dose >2 mg or prolonged dexamethasone therapy (>2 days, totaling 4 mg) preceding corticotropin stimulation has not been studied in any population.

Key Words: adrenal insufficiency, corticosteroid, corticotropin stimulation test, critical care

Published Online, January 11, 2005. www.theannals.com, DOI 10.1345/aph.1E353