During critical illness, glucocorticoid secretion markedly increases, but the increase is not discernible when only the serum total cortisol concentration is measured. In this study, nearly 40 percent of critically ill patients with hypoproteinemia had subnormal serum total cortisol concentrations, even though their adrenal function was normal. Measuring serum free cortisol concentrations in critically ill patients with hypoproteinemia may help prevent the unnecessary use of glucocorticoid therapy.

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The US Preventive Services Task Force (USPSTF) currently recommends initiating breast cancer screening at 50 years of age in patients at average risk. 1 However, we hypothesize that these guidelines may not be sensitive to racial differences and may be inappropriately extrapolating data from largely white populations for use in racially diverse populations. This process could result in underscreening of nonwhite female patients. These concerns are similar to broader discussions regarding sex bias in the clinical research process, leading to recent policy changes at the National Institutes of Health and the US Food and Drug Administration. 2 The goal of this study is to assess the age distribution of breast cancer diagnosis across race/ethnicity in the United States.Methods | We analyzed the Surveillance, Epidemiology, and End Results (SEER) Program database from January 1, 1973, through December 31, 2010. Female patients aged 40 to 75 years with malignant breast neoplasms were included. The primary end point was age and stage at breast cancer diagnosis across racial groups. Institutional review board approval was not required because these data are publicly available.