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Related Concept Videos

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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Anatomy of the Adrenal Glands01:17

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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...
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Hormones of the Adrenal Glands01:31

Hormones of the Adrenal Glands

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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...
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Stress Response System01:21

Stress Response System

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The stress response system, also known as the fight-or-flight response, is the body's automatic physiological reaction to perceived threats. Hans Selye introduced the concept of General Adaptation Syndrome (GAS) to describe the predictable pattern of changes that occur in response to stress. GAS consists of three sequential stages: alarm, resistance, and exhaustion. This model helps explain how chronic stress can contribute to health problems.
Alarm stage
In the alarm stage, the body's...
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Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

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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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Immunodeficiency Diseases01:25

Immunodeficiency Diseases

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Immunodeficiency disorders are conditions in which the immune system's ability to fight infectious disease and cancer is compromised or entirely absent. The immune system comprises a complex network of cells, tissues, and organs that work together to protect the body from potentially harmful invaders. When this system is deficient or not functioning properly, it leaves the body susceptible to infections, diseases, or other complications.
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Related Experiment Video

Updated: Jul 25, 2025

Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
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Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression

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Sepsis and Adrenal Insufficiency.

Cosmo Fowler1, Nina Raoof1, Stephen M Pastores1

  • 1Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Journal of Intensive Care Medicine
|June 27, 2023
PubMed
Summary

Critical illness-related corticosteroid insufficiency (CIRCI) in sepsis presents nonspecific symptoms and challenges in diagnosis and treatment. This review synthesizes evidence on corticosteroid use, focusing on shock duration, mortality, and adverse effects.

Keywords:
adrenal insufficiencycorticosteroidscritical illnesshydrocortisonesepsisseptic shock

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Area of Science:

  • Critical care medicine
  • Endocrinology
  • Infectious diseases

Background:

  • Sepsis can lead to critical illness-related corticosteroid insufficiency (CIRCI) due to hypothalamic-pituitary-adrenal axis dysregulation, altered cortisol metabolism, and glucocorticoid resistance.
  • CIRCI in sepsis presents with nonspecific signs like altered mental status, fever, and refractory hypotension, often requiring vasopressors.
  • Despite being recognized for over a decade, CIRCI remains poorly understood, difficult to diagnose, and associated with varied clinical practices regarding corticosteroid therapy.

Purpose of the Study:

  • To provide a comprehensive, evidence-based review of current recommendations for diagnosing and managing CIRCI in sepsis.
  • To explore existing controversies surrounding corticosteroid use in sepsis and septic shock.
  • To highlight emerging evidence and future directions in the management of CIRCI.

Main Methods:

  • Review of existing literature, including dozens of randomized controlled trials on corticosteroid use in sepsis and septic shock over the past four decades.
  • Synthesis of evidence regarding the effects of corticosteroids on shock duration, mortality, and adverse events.
  • Analysis of current diagnostic and management strategies for CIRCI.

Main Results:

  • Corticosteroid therapy in sepsis and septic shock has consistently reduced the duration of shock.
  • The impact of corticosteroids on mortality in sepsis remains inconsistent across studies.
  • Adverse effects associated with corticosteroid use include hyperglycemia, neuromuscular weakness, and increased infection risk.

Conclusions:

  • Management of CIRCI in sepsis requires careful consideration of benefits (reduced shock duration) against risks (inconsistent mortality benefit, adverse effects).
  • Further research is needed to clarify optimal corticosteroid dosing and duration for sepsis-induced CIRCI.
  • Evolving evidence continues to shape clinical practice for CIRCI in critically ill patients.