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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...
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...
Acute Inflammation III: Local and Systemic Effects01:25

Acute Inflammation III: Local and Systemic Effects

Acute inflammation produces a coordinated set of local and systemic changes that limit injury, eliminate pathogens, and initiate repair. These responses arise within minutes of infection, trauma, or chemical insult and are driven by vascular alterations and leukocyte-derived mediators. When the stimulus resolves, the reaction typically abates within days.Local EffectsAt the site of injury, arteriolar vasodilation increases blood flow, resulting in redness and warmth. Simultaneously, increased...
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...
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...
Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...

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Adrenal function in sepsis and septic shock.

Cristiane Freitas Pizarro1, Eduardo Juan Troster

  • 1Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. crispizarro@terra.com.br

Jornal De Pediatria
|November 8, 2007
PubMed
Summary

Adrenal insufficiency is common in pediatric sepsis and septic shock, potentially causing refractory shock. The effectiveness of low-dose steroid therapy in these critically ill children requires further investigation.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Endocrinology
  • Infectious Diseases

Background:

  • Adrenal insufficiency is a recognized complication in pediatric patients experiencing severe sepsis and septic shock.
  • This condition may contribute to the development of catecholamine-refractory shock, a severe and life-threatening complication.

Purpose of the Study:

  • To review the diagnostic criteria for adrenal insufficiency in pediatric patients with severe sepsis and septic shock.
  • To examine the current treatment strategies for this condition in the pediatric population.

Main Methods:

  • A literature search was conducted using MEDLINE, Embase, and Cochrane Library databases.
  • Keywords included "septic shock," "sepsis," "corticosteroids," "adrenal insufficiency," and "children."

Main Results:

  • Diagnostic criteria for adrenal insufficiency in critically ill children are not well-established, leading to a wide incidence range (15%-61%).
  • The rapid corticotropin stimulation test is commonly used, with ongoing debate regarding optimal corticotropin dosage (standard 250 microg vs. proposed sensitive 1 microg).
  • The efficacy of low-dose corticosteroids in children with catecholamine-refractory shock remains uncertain, necessitating further research.

Conclusions:

  • Adrenal insufficiency is prevalent in pediatric severe sepsis and septic shock and may be a factor in catecholamine-refractory shock.
  • Further research is needed to clarify the impact of low-dose steroid replacement therapy on morbidity and mortality in these patients.