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Related Concept Videos

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 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...
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...
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...
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...
Hypothalamic-Pituitary Axis01:37

Hypothalamic-Pituitary Axis

The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.

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A Novel Method: Super-selective Adrenal Venous Sampling
06:08

A Novel Method: Super-selective Adrenal Venous Sampling

Published on: September 15, 2017

Relative adrenal insufficiency.

Donald L Loriaux1, Maria Fleseriu

  • 1Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA. loriauxl@ohsu.edu

Current Opinion in Endocrinology, Diabetes, and Obesity
|August 6, 2009
PubMed
Summary
This summary is machine-generated.

This review examines acute adrenal insufficiency in critically ill patients, questioning the clinical utility of "relative adrenal insufficiency" and proposing a diagnostic approach to avoid unnecessary glucocorticoid treatment.

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Last Updated: Jun 21, 2026

A Novel Method: Super-selective Adrenal Venous Sampling
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Published on: September 15, 2017

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Published on: October 2, 2018

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Internal Medicine

Background:

  • Acute adrenal insufficiency is a critical condition requiring prompt diagnosis and management.
  • The concept of 'relative adrenal insufficiency' is frequently applied to critically ill patients with sepsis or cardiogenic shock.
  • This concept suggests a high prevalence of adrenal dysfunction in intensive care units.

Purpose of the Study:

  • To review the clinical presentation, diagnosis, and treatment of acute adrenal insufficiency.
  • To critically evaluate the concept and clinical utility of 'relative adrenal insufficiency' in critically ill patients.
  • To propose a practical approach for identifying true adrenal insufficiency and preventing overtreatment.

Main Methods:

  • Literature review of clinical presentations, diagnostic criteria, and treatment strategies for adrenal insufficiency.
  • Critical analysis of studies supporting the concept of 'relative adrenal insufficiency'.
  • Development of a diagnostic algorithm for adrenal insufficiency in the intensive care setting.

Main Results:

  • The concept of 'relative adrenal insufficiency' in critically ill patients lacks clear clinical utility.
  • Current diagnostic and treatment paradigms may lead to the overuse of glucocorticoids.
  • A significant proportion of critically ill patients may be unnecessarily treated for adrenal insufficiency.

Conclusions:

  • A refined approach is needed to accurately diagnose adrenal insufficiency in critically ill patients.
  • Distinguishing true adrenal insufficiency from stress-induced physiological changes is crucial.
  • Avoiding unnecessary high-dose glucocorticoid therapy in the absence of confirmed adrenal insufficiency is essential for patient safety.