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[Corticosteroids in septic shock].

M Clodi1

  • 1Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien. martin.clodi@univie.ac.at

Wiener Medizinische Wochenschrift (1946)
|January 1, 2003
PubMed
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Critically ill patients often have high cortisol levels, but hydrocortisone treatment can improve hemodynamic recovery and reduce mortality in septic shock. This suggests relative adrenal insufficiency may be a factor in critical illness.

Area of Science:

  • Endocrinology
  • Critical Care Medicine

Context:

  • Critical illness necessitates adequate adrenocortical function for survival.
  • Most critically ill patients exhibit elevated plasma cortisol, indicating pituitary-adrenal axis activation as a homeostatic response.

Purpose:

  • To review glucocorticoid physiology and regulation during septic shock.
  • To discuss the effects of hydrocortisone administration in septic shock patients.

Summary:

  • Elevated cortisol in critical illness is a homeostatic adaptation, but neuroendocrine response failure can cause refractory hypotension.
  • Hydrocortisone administration in septic shock has shown more rapid hemodynamic recovery and reduced mortality in randomized trials.
  • Relative adrenal insufficiency, due to hypothalamic-pituitary-adrenal axis dysfunction or cortisol resistance, is implicated.

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Impact:

  • Findings support the concept of relative adrenal insufficiency in critical illness.
  • Evidence suggests stress doses of hydrocortisone can decrease mortality in septic shock.
  • Ongoing trials like CORTICUS further investigate hydrocortisone's mortality benefit in septic shock.