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Decreased Adrenal Responsiveness in Hypothermic Patients^*

Department of Medicine, University of Washington Washington 98195

Address requests for reprints to: William L. Green, M.D., Harborview Medical Center, 325 9th Avenue, Seattle, Washington 98104.

We have performed ACTH stimulation tests in a total of 14 subjects who werehypothermic at the time of initial presentation. Plasma cortisol values were measured before and 1 h after an iv dose of 25 U synthetic ACTH. The cortisol response was depressed in these subjects, with a mean rise of 32% and an absolute mean rise of 5.0 µg/dl. There appeared to be a temperature threshold effect, with only minimalresponses observed below 32 C. A subgroup of 5 patients with sluggish responses to ACTH while hypothermic (mean cortisol rise, 12.5%) were retested after warming and responded normally (mean rise, 166%). Thus, ACTH stimulation tests may be misleadingin the hypothermic patient and should be performed only after body temperature has returned to normal.

^* This work was supported by USPHS Grants AM-15810 and AM-10866.

Received June 8, 1979.

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