Related Experiment Videos
Adrenal function in different subgroups of septic shock patients
D R Salgado1, J R Rocco, J C Rosso Verdeal
1Intensive Care Unit, Barra D'or Hospital, Rio de Janeiro, RJ, Brazil, and Internal Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. d.salgado@globo.com
Acta Anaesthesiologica Scandinavica
|November 15, 2007
Summary
Female gender, bacteremia, and early acute respiratory distress syndrome (ARDS) are linked to higher rates of relative adrenal insufficiency (RAI) in septic shock patients. Other factors did not show a significant association with RAI incidence.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Infectious Diseases
Background:
- Relative adrenal insufficiency (RAI) is a frequent complication in septic shock.
- RAI incidence may vary across different patient subgroups.
- Understanding these variations is crucial for targeted management.
Purpose of the Study:
- To determine adrenal function and RAI incidence in septic shock subgroups.
- To investigate associations with admission categories, infection source, infection type, demographics, and comorbidities.
- To identify specific patient profiles at higher risk for RAI.
Main Methods:
- Prospective study of 102 adult septic shock patients in a medical-surgical ICU (May 2002-May 2005).
- Total serum cortisol measured at baseline and 60 min after high-dose ACTH test within 96 hours of shock onset.
- RAI defined as serum cortisol increment (Deltamax) <90 microg/l.
Main Results:
- Overall RAI incidence was 22.5%.
- Female gender, bacteremia, and ARDS developing before ACTH testing were independently associated with higher RAI incidence.
- No significant differences in RAI incidence were found based on age, neurological diseases, or admission/infection characteristics.
Conclusions:
- Female sex, bacteremia, and early-onset ARDS are key independent predictors of RAI in septic shock.
- These findings highlight specific subgroups requiring closer monitoring for adrenal dysfunction.
- Adrenal function assessment in septic shock should consider these identified risk factors.
Related Concept Videos
01:27Adrenal 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...
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...
01:30Adrenergic Agonists: Therapeutic Uses
Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
01:26Adrenergic Receptors: β Subtype
β-adrenoceptors have varied sensitivities towards adrenaline, noradrenaline, and isoprenaline. The order of agonist potency is as follows:
Isoprenaline > Adrenaline > Noradrenaline
Neurotransmitter binding to these receptors causes activation of adenylyl cyclase resulting in increased concentrations of cAMP and modulation of calcium ion channels within the cell. They are further classified into β1, β2, and β3 subtypes.
β1-adrenoceptors: β1-adrenoceptors have equal affinities for...
Isoprenaline > Adrenaline > Noradrenaline
Neurotransmitter binding to these receptors causes activation of adenylyl cyclase resulting in increased concentrations of cAMP and modulation of calcium ion channels within the cell. They are further classified into β1, β2, and β3 subtypes.
β1-adrenoceptors: β1-adrenoceptors have equal affinities for...
01:31Hormones 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...
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...
01:17Anatomy 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...
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...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...