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Adrenal insufficiency in critical illness.
Mark Stuart Cooper1, Paul Michael Stewart
1Department of Endocrinology, Division of Medical Sciences, Institute of Biomedical Research, The University of Birmingham, United Kingdom. m.s.cooper@bham.ac.uk
Journal of Intensive Care Medicine
|December 1, 2007
Summary
Adrenal insufficiency in critical care lacks consensus on diagnosis and treatment. This review clarifies glucocorticoid changes and guides corticosteroid replacement for critically ill patients.
Area of Science:
- Critical care medicine
- Endocrinology
Background:
- Adrenal insufficiency and corticosteroid treatment in critically ill patients remain controversial.
- Lack of consensus exists regarding diagnosis, testing, interpretation, and treatment protocols.
Purpose of the Study:
- To review pathophysiological changes in glucocorticoid secretion, metabolism, and action during critical illness.
- To provide guidance on adrenal function testing and corticosteroid replacement regimens.
Main Methods:
- Literature review of current published data on adrenal insufficiency in critical care.
- Analysis of pathophysiological changes in glucocorticoid dynamics.
- Evaluation of diagnostic testing and treatment strategies.
Main Results:
- Critical illness significantly alters glucocorticoid secretion, metabolism, and action.
- Interpreting glucocorticoid replacement effects is complex due to diverse tissue actions.
- Distinguishing between adrenal and central causes of insufficiency is crucial for treatment.
Conclusions:
- Adrenal insufficiency management in critical care requires careful consideration of complex pathophysiological changes.
- Evidence-based guidance on testing and corticosteroid replacement is needed.
- Tailored investigation and treatment based on the origin of insufficiency are essential.
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