Adrenal Insufficiency in the Critically Ill: A New Look at an Old Problem

Chest. 2002 Nov;122(5):1784-96. doi: 10.1378/chest.122.5.1784.

Abstract

Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and management of HPA dysfunction in the critically ill.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adrenal Gland Diseases / complications*
  • Adrenal Gland Diseases / etiology
  • Adrenal Gland Diseases / physiopathology
  • Adrenal Gland Diseases / therapy
  • Critical Illness*
  • Cytokines / physiology
  • Glucocorticoids / physiology
  • Humans
  • Hydrocortisone / metabolism
  • Hypothalamic Diseases / complications*
  • Hypothalamic Diseases / diagnosis
  • Hypothalamic Diseases / etiology
  • Hypothalamic Diseases / physiopathology
  • Hypothalamic Diseases / therapy
  • Hypothalamo-Hypophyseal System / physiology
  • Pituitary-Adrenal System / physiology
  • Prognosis
  • Sepsis / complications
  • Stress, Physiological / immunology

Substances

  • Cytokines
  • Glucocorticoids
  • Hydrocortisone