Adrenal Insufficiency in the Critically Ill*
A New Look at an Old Problem
- Paul E. Marik, MD, FCCP and
- Gary P. Zaloga, MD, FCCP
Abstract
Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and management of HPA dysfunction in the critically ill.
Footnotes
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Abbreviations: ACTH = adrenal corticotropin hormone; CRH = corticotropin-releasing hormone; GR = glucocorticoid receptor; HD-ACTH = high-dose adrenal corticotropin stimulation; HPA = hypothalamic-pituitary-adrenal; IL = interleukin; LD-ACTH = low-dose adrenal corticotropin stimulation; Δmax = change in cortisol level following corticotropin stimulation; SIRS = systemic inflammatory response syndrome; TNF = tumor necrosis factor
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- Accepted April 12, 2002.
- Received February 8, 2002.
