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Adrenal Gland Disorders01:27

Adrenal Gland Disorders

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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...
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Cushing Syndrome II: Pathophysiology01:19

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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...
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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Acute Inflammation II: Local and Systemic Effects01:25

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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...
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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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Cushing Syndrome I: Introduction01:26

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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...
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Related Experiment Video

Updated: Apr 22, 2026

Cecal Ligation Puncture Procedure
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Adrenal insufficiency in sepsis.

Andrea Polito1, Jérôme Aboab1, Djillali Annane1

  • 1Hopital Raymond Poincare, Assistance Publique-Hopitaux de Paris, Faculte de Medecine Paris Ile de France Ouest, Universite de Versailles Saint-Quentin en Yvelines, Garches, France.

Revista Brasileira De Terapia Intensiva
|October 14, 2014
PubMed
Summary

Adrenal insufficiency (AI) can cause hemodynamic instability during sepsis. Early ACTH testing and hydrocortisone/fludrocortisone replacement therapy are recommended for non-responders, guiding treatment duration for critically ill patients.

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Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Corticosteroids have a long history in treating severe infections.
  • Past trials with high-dose, short-term glucocorticoids in sepsis showed limited benefit.
  • Recent findings link septic shock to adrenal insufficiency and glucocorticoid receptor resistance, renewing interest in low-dose, long-term corticosteroid therapy.

Purpose of the Study:

  • To review the role of corticosteroids in the host response to stress.
  • To update readers on validated corticosteroid treatment indications in the ICU.
  • To explore the implications of adrenal insufficiency in critically ill patients.

Main Methods:

  • Extensive review of adrenal physiology and pathophysiology in critical illness.
  • Analysis of clinical implications of adrenal dysfunction in critically ill patients.
  • Evaluation of ACTH testing and corticosteroid replacement therapy protocols.

Main Results:

  • Adrenal insufficiency (AI) can lead to hemodynamic instability and persistent inflammation in sepsis.
  • An ACTH test is crucial for identifying non-overt AI.
  • Replacement therapy with hydrocortisone and fludrocortisone is suggested for AI.

Conclusions:

  • Prompt ACTH testing and subsequent corticosteroid replacement therapy are recommended for sepsis-induced AI.
  • Treatment duration should be guided by ACTH test response.
  • Further research is needed to evaluate corticosteroid use in patients with high baseline cortisol levels and potential receptor resistance.