Recently published papers: inflammation, elucidation, manipulation?

The search for the marker in sepsis and inflammation continues. Perhaps when we do find it we may be able to alter and influence the underlying pathophysiology of sepsis. Many reports from those who believe that this may lie in the hypothalamic–pituitary–adrenal axis have recently been published. Manglik and colleagues [1] looked into secondary adrenocortical insufficiency in patients who present with severe sepsis. Measuring maximal cortisol secretion after stimulation with adrenocorticotrophic hormone, those investigators found that 9% of their population failed an adrenocorticotrophic hormone stimulation test. Four per cent had previously undiagnosed pituitary disease and 5% were suffering from sepsis-related adrenal dysfunction. They used absolute cortisol levels and not delta cortisol to define adrenocortical insufficiency, but until we have an established definition for adrenocortical insufficiency in sepsis the studies will continue to yield disparate results.