Adrenocortical Insufficiency in Critical Illness

3.12.5 - Adrenocortical Insufficiency in Critical Illness

from Section 3.12 - Endocrine Disorders

Published online by Cambridge University Press: 27 July 2023

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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Summary

Key Learning Points

1. The hypothalamic–pituitary–adrenal axis plays a key role in the stress response to critical illness.
2. Critical illness-related corticosteroid insufficiency (CIRCI) is thought to occur when this response is inadequate to the severity of the metabolic stress encountered.
3. CIRCI should be distinguished from other forms of primary hypoadrenalism encountered in critical care.
4. There is currently no agreed definition nor diagnostic criteria for diagnosing CIRCI.
5. Supplemental corticosteroids should be considered for those patients thought to have CIRCI, with refractory hypotension in the context of sepsis, despite conflicting evidence of any benefit in clinical trials.

Keywords

sepsis steroids shock critical illness-related corticosteroid insufficiency

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 391 - 392

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

References and Further Reading

Annane, D, Sebille, V, Charpentier, C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862–71.Google Scholar

Messotten, D, Vanhorebeek, I, Van den Berghe, G. The altered adrenal axis and treatment with glucocorticoids during critical illness. Nat Clin Pract Endocrinol Metab 2008;4:496–505.Google Scholar

Rhodes, A, Evans, LE, Alhazzani, W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2016. Crit Care Med 2017;45:486–552.CrossRef Google Scholar PubMed

Sprung, CL, Annane, D, Keh, D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008;358:111–24.CrossRef Google Scholar PubMed

Venkatash, B, Finfer, S, Cohen, J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018;378:797–808.Google Scholar