• Emil A Pastrana, Fanor M Saavedra, Gisela Murray, Samuel Estronza, John D Rolston, and Gloria Rodriguez-Vega.
• Department of Surgery, Neurosurgery Section, University of Puerto Rico, San Juan, Puerto Rico. emilapastrana@gmail.com
• World Neurosurg. 2012 Mar 1; 77 (3-4): 561-3.

BackgroundAdequate adrenal response is fundamental for the maintenance of physiological homeostasis in the setting of trauma and severe illness. Patients with neurogenic shock are at risk of severe consequences if adrenal insufficiency (AI) is not rapidly identified and treated.ObjectiveTo analyze the incidence of AI in patients with acute cervical spinal cord injury and its effect on in-hospital complications.MethodsThe medical records of patients older than 18 years who were admitted to the adult neurosurgery service at the University District Hospital as the result of neurogenic shock after acute cervical spinal cord injury from January 2004 to December 2009 were reviewed retrospectively.ResultsOne hundred ninety-nine patients were admitted with acute cervical spinal cord injury. A total of 37 patients met the pre-established criteria for neurogenic shock. The incidence of AI in patients with neurogenic shock was 22%. The average random cortisol was 9.3 μg/dL in patients with AI versus 29.2 μg/dL in non-AI. The presence of AI was positively correlated with complications and an increase in the risk of intubation (P = 0.01 and P = 0.002). The 30-day mortality rate in patients with AI was 13% compared with the 3% in the non-AI group (P = 0.39).ConclusionsAdrenal insufficiency is a poorly recognized complication in patients with acute cervical spinal cord injury and its aggressive treatment is of utmost importance to avoid further neurological injury.Copyright © 2012 Elsevier Inc. All rights reserved.

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