Why eosinophilia in adrenal insufficiency

In 82 percent of the patients treated with hydrocortisone, a response was evidenced within 24 hours of treatment by a decrease in the required inotropic support by more than 50 percent, an increase in the mean arterial blood pressure of more than 25 percent, or both. Conclusions: New-onset eosinophilia may be a useful marker for adrenal insufficiency. Prompt testing and diagnosis may avoid the occurrence of a treatable, life-threatening condition.

More on this in the IBCC chapter on adrenal insufficiency here. The neutrophil to lymphocyte ratio NLR is a marker of physiologic stress. In a shocked patient, this really ought to be elevated. A NLR on the low end of normal is really strange in a patient with shock.

One of the major drivers of NLR is the cortisol level cortisol increases the neutrophil count and reduces the lymphocyte count :.

So the presence of clinical shock with a normal NLR suggests an inadequate cortisol level i. This might be the first case report of an inappropriately normal NLR being used to diagnose adrenal crisis. So I can't comment on the sensitivity or specificity of a normal NLR to diagnose adrenal insufficiency. More on the NLR here. Case resolution : The patient was started immediately on IV dexamethasone 6 mg with clinical improvement.

Meanwhile an ACTH stimulation test was performed which confirmed the presence of adrenal insufficiency. A similar case: This may not be quite as much of a zebra as it might seem. Metrics details. Adequate adrenocortical function is essential to survive critical illness. The number of circulating eosinophils has been proposed as a marker of adrenocortical function.

The goal of the present study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock. During a 1-year period, we studied prospectively all patients admitted to our ICU. The mean age was The mean eosinophil count was 6.

Eosinophilia was present 1. Multidrug-resistant Gram-negative bacteria in 14 patients, Gram-positive in three patients and fungi in two patients were isolated and considered responsible for sepsis. Baseline cortisol levels were The day mortality following the onset of septic shock was Relative eosinophilia may be considered a useful and early bioassay for adrenocortical function assessment in critically ill patients with severe septic shock and assumed adrenocortical depression.