To the Editor.
—Glezen, in his editorial on the prevention of influenzarelated morbidity and mortality published in the Archives (1982;142:25-26), calls attention to the increased fatality from influenza in young persons without evidence of underlying disease as well as the more widely emphasized increased risk in older patients with previous chronic illness.1 He also properly stresses the need for better vaccination programs and the use of amantadine hydrochloride as supplementary therapy. Because there is evidence that the influenza virus interferes with normal pituitary-adrenal response to the stress of the infection2,3 and because resistance to influenza seems to be lowered more by untreated adrenocortical insufficiency than by chronic cardiac or renal disease,4 it is possible that fatalities in previously healthy persons may be related to relative adrenocortical insufficiency. Hence, plasma cortisol levels should be determined in patients acutely ill with influenza, and, if the levels are not elevated
Jefferies WM. Influenza-Related Morbidity and Mortality. Arch Intern Med. 1982;142(6):1240. doi:10.1001/archinte.1982.00340190200038