Adrenal insufficiency in prolonged critical illness

MECHANISMS IN ENDOCRINOLOGY: New concepts to further unravel adrenal insufficiency during critical illness.

The concept of 'relative' adrenal insufficiency during critical illness remains a highly debated disease entity. Several studies have addressed how to diagnose or treat this condition but have often yielded conflicting results, which further fuelled the controversy. The main reason for the controversy is the fact that the pathophysiology is not completely understood. Recently, new insights in t...

Mechanisms and clinical consequences of critical illness associated adrenal insufficiency.

PURPOSE OF REVIEW Adrenal insufficiency is being diagnosed with increasing frequency in critically ill patients. There exists, however, much controversy in the literature as to the nature of this entity, including its pathophysiology, epidemiology, diagnosis and treatment. The review summarizes our current understanding of the causes and consequences of adrenal insufficiency in critically ill p...

Adrenal Insufficiency in the Icu: Is It Just Addison’s?

INTRODUCTION Critical illness-related corticosteroid insufficiency (CIRCI), previously known as relative adrenal insufficiency, is a syndrome of relative, as opposed to absolute adrenal dysfunction observed in critically ill patients. Initially observed in septic patients, CIRCI has been documented in many other forms of critical illness, primarily in human medicine, such as pancreatitis and tr...

Assessing adrenal insufficiency of corticosteroid steroid secretion using free versus total cortisol levels in critical illness

Critical illness-related corticosteroid insufficiency in children.

Adequate adrenocortical function is essential for survival in critical illness. Most critically ill patients display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic-pituitary-adrenal axis and is considered to be a homeostatic adaptation. However, many critically ill patients have 'relative' or 'functional' adrenal insufficiency, which is characterized by a...