Related Experiment Video
Updated: May 29, 2026
11:53
Cecal Ligation Puncture Procedure
Published on: May 7, 2011
Adrenocortical (dys)function in septic shock - a sick euadrenal state
1Princess Alexandra and Wesley hospitals, University of Queensland, Brisbane, Australia. Bala_Venkatesh@health.qld.gov.au
Best Practice & Research. Clinical Endocrinology & Metabolism
|September 20, 2011
Summary
Septic shock may involve "sick euadrenal syndrome" rather than adrenal insufficiency. This challenges current views on glucocorticoid treatment in critical illness, suggesting plasma levels may not reflect tissue activity.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Pathophysiology
Background:
- Septic shock pathophysiology is linked to adrenal dysfunction.
- Terms like Relative Adrenal Insufficiency (RAI) and Critical Illness Related Corticosteroid Insufficiency (CIRCI) describe changes in glucocorticoid activity.
- Current diagnostic criteria based on plasma cortisol are difficult to establish and may not reflect cellular glucocorticoid deficiency.
Purpose of the Study:
- To propose an alternative framework for understanding adrenocortical dysfunction in sepsis.
- To challenge the prevailing concept of adrenal insufficiency in septic shock.
Main Methods:
- Review of existing literature on endocrine changes in septic shock.
- Analysis of plasma cortisol profiles versus tissue glucocorticoid activity.
Main Results:
- Plasma cortisol profiles may not reliably indicate tissue glucocorticoid activity in severe sepsis.
- Emerging data suggest abnormalities in tissue glucocorticoid activity.
Conclusions:
- The spectrum of adrenocortical dysfunction in sepsis, affecting both plasma and tissue, can be reclassified as "sick euadrenal syndrome".
- This reframing offers a new perspective on glucocorticoid dynamics in septic shock, distinct from traditional notions of insufficiency.
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...
01:19Cushing 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...
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:...
01:26Cushing 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...
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...