Hypothalamic-pituitary-adrenal insufficiency

Crit Care Clin. 2001 Jan;17(1):25-41. doi: 10.1016/s0749-0704(05)70150-0.


Adrenal insufficiency is a common and underdiagnosed disorder that develops in critically ill patients. Most forms are acquired and will resolve with treatment of the underlying disease. Hypotension that is refractory to fluids and requires vasopressors is the most common presentation of adrenal insufficiency in the ICU. It is important to make the diagnosis of adrenal insufficiency, because current data suggest that treatment with glucocorticoids improves outcome. Diagnosis usually can be made on the basis of a stress cortisol level. Occasionally, when the level of stress is uncertain, the low-dose corticotropin stimulation test will be required for definitive diagnosis. A therapeutic trial with hydrocortisone should be started in patients with suspected adrenal insufficiency pending results of diagnostic testing.

Publication types

  • Review

MeSH terms

  • Adrenal Insufficiency* / diagnosis
  • Adrenal Insufficiency* / epidemiology
  • Adrenal Insufficiency* / etiology
  • Adrenal Insufficiency* / physiopathology
  • Adrenal Insufficiency* / therapy
  • Critical Illness
  • Humans
  • Hydrocortisone / deficiency
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Incidence
  • Pituitary-Adrenal System / physiopathology*


  • Hydrocortisone