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Related Concept Videos

Cushing Syndrome II: Pathophysiology01:19

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
Adrenal Gland Disorders01:27

Adrenal Gland Disorders

Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Cushing Syndrome I: Introduction01:26

Cushing Syndrome I: Introduction

Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
Hormones of the Adrenal Glands01:31

Hormones of the Adrenal Glands

Adrenal hormones play a pivotal role in maintaining the body's electrolyte balance and orchestrating responses to stress, showcasing the intricate functions of the adrenal cortex and medulla.
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and corticosterone...
Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
Anatomy of the Adrenal Glands01:17

Anatomy of the Adrenal Glands

The adrenal or supra-renal glands, situated above the kidneys and aligned with the twelfth rib, are paired pyramid-shaped structures crucial for the body's stress response. During stress, these glands secrete hormones vital for adaptive physiological reactions.
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct regions...

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Related Experiment Videos

Adrenal function in sepsis: the retrospective Corticus cohort study.

Diane Lipiner-Friedman1, Charles L Sprung, Pierre François Laterre

  • 1Service de Réanimation, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), Garches, France.

Critical Care Medicine
|March 6, 2007
PubMed
Summary

Higher baseline cortisol and lower delta cortisol levels are associated with increased mortality in severe sepsis. These findings highlight the importance of cortisol assessment in critically ill patients.

Related Experiment Videos

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Sepsis Pathophysiology

Background:

  • Adrenal insufficiency is a concern in severe sepsis and septic shock.
  • Cortisol levels are used to assess adrenal function.
  • The prognostic value of baseline and stimulated cortisol requires further clarification.

Purpose of the Study:

  • To refine the prognostic value of baseline and adrenocorticotropin hormone (ACTH)-stimulated cortisol levels.
  • To investigate the association between cortisol levels and mortality in severe sepsis or septic shock.

Main Methods:

  • Retrospective multicenter cohort study.
  • Included 477 patients with severe sepsis/septic shock.
  • ACTH stimulation test performed on day of sepsis onset.

Main Results:

  • Nonsurvivors had higher baseline cortisol (29.5 vs. 24.3 microg/dL) and lower delta cortisol (6.4 vs. 10.9 microg/dL) compared to survivors.
  • Low baseline cortisol (<15 microg/dL) or low delta cortisol (<=9 microg/dL) predicted increased mortality risk (LR 1.26-1.38).
  • Etomidate use was associated with worse outcomes and affected ACTH test results.

Conclusions:

  • Delta cortisol, not baseline cortisol, is associated with clinical outcome in severe sepsis.
  • Further research is needed to optimize adrenal insufficiency diagnosis in critical illness.
  • Etomidate use complicates interpretation of ACTH test results and prognosis.