Abstract
Adrenal insufficiency during critical illness was first described by Hans Selye in 1949, in which he described a stress response that occurs when an event threatens an organism’s well-being. Since that time, adrenal insufficiency has been well recognized outside of the critical care setting and is defined as a failing in cortisol production resulting in low baseline cortisol levels, with no response to the ACTH stimulation test. More recently it has been recognized that a transient state of relative adrenal insufficiency occurs in patients within the critical care setting. The reported evidence of this critical illness corticosteroid insufficiency (CIRC) in critically ill patients varies widely (0–77%), depending on the population of patients studied and the diagnostic criteria. In addition, the underlying mechanism surrounding the disorder remains poorly understood.
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References
Gabrelli A, Layon AJ, Yu M. Endocrine disease and dysfunction. In: Gabrelli A, Layon AJ, Yu M. editors. Civetta, Taylor & Kirby’s: critical care. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2014.
Park YJ, Park KS, Kim JH, et al. Reproducibility of the cortisol response to stimulation with the low dose (1 microg) of ACTH. Clin Endocrinol. 1999;51:153–8.
Burman D, Morrison GD. Too many infant deaths. Be Med J. 1963;2:1419–20.
Benson S, Neumann P, Unger N, et al. Effects of standard glucocorticoid replacement therapies on subjective well being: a randomized, double blind, crossover study in patients with secondary adrenal insufficiency. Eur J Endocrinol. 2012;167:679–85.
Hahner S, Loeffler M, Fassnacht M, et al. Impaired subjective health status in 256 patients with adrenal insufficiency or standard therapy based on cross-sectional analysis. J Clin Endocrinol Metab. 2007;92:3912–22.
Bancos I, Hahner S, Tommlinson J, Arlt W. 2014 diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3:216–26.
de Miguel Novoa P, Vela ET, Garcia NP, et al. Guidelines for the diagnosis and treatment of adrenal insufficiency in the adult. Endocrinol Nutr. 2014;1(61 Suppl):1–35.
Ospina NS, Nofal A, Murad H, et al. ACTH stimulation tests for diagnosis of adrenal insufficiency: systematic review and meta-analysis. J Clin Endocrinol Metab. 2016;101(2):427–34.
Brennan A, O’Connor KA, Plant WD, O’Halloran DJ. Nephrotic syndrome: cause of an abnormal response to the rapid ACTH stimulation test. Nephrol Dial Transplant. 2004;19:477.
Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem. 2009;46:351–67.
Cho YJ, Mono JY, Shin ES, Won C, et al. Clinical practice guideline of acute respiratory distress syndrome. Tuber Respir Dis. 2016;79:241–33.
Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A. Corticosteroids in the prevention and treatment of ARDS in adults; meta-analysis. Crit Care Med. 2009;37:1594–603.
Meduri GU, Marik PE, Chorousos GP, Pastores SM, Arlt W, et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med. 2008;34:61–9.
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Cohen, E., Biffl, W.L. (2018). Adrenal Insufficiency. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_45
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DOI: https://doi.org/10.1007/978-3-319-71712-8_45
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