This paper is only available as a PDF. To read, Please Download here.
Although true adrenal insufficiency is an uncommon event in the intensive care unit,
the question of its presence is often considered. In addition, the use of exogenous
glucocorticoids is so widespread that the possibility of secondary adrenal insufficiency
is a frequent concern. Careful history taking and physical examination complemented
by review of the laboratory data and the awareness of certain risk factors should
help identify most cases. The presentation is often not classic and empiric therapy
may be required while awaiting results of diagnostic testing.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Critical Care ClinicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Glucocorticoid therapy.Medicine. 1976; 55: 39
- Stress hormones: Their interactions and regulation.Science. 1984; 244: 452
- The adrenal cortex.in: Felig P. Baxter J.D. Broadus A.E. Endocrinology and Metabolism. McGraw-Hill, New York1987: 511
- Interrelations between adrenocortical functions and infectious illness.N Engl J Med. 1969; 280: 541
- Immunoregulatory feedback between interleukin-1 and glucocorticoid hormones.Science. 1986; 233: 652
- The diagnosis and treatment of adrenal insufficiency.in: DeGroot L.J. Besser G.M. Cahill G.F. Endocrinology. ed 2. WB Saunders, Philadelphia1989: 1647
- Estimation of the rate of release of adrenal 17-hydroxycorticosterone in the human being by venous catheter technique with a method for determining plasma 17-hydroxycorticosteroids.J Clin Invest. 1953; 32: 703
- A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.N Engl J Med. 1987; 317: 653
- Discordant cortisol response to exogenous ACTH and insulin-induced hypoglycemia in patients with pituitary disease.N Engl J Med. 1982; 306: 1462
- Withdrawal from glucocorticoid therapy.N Engl J Med. 1976; 295: 30
- Hormonal responses to graded surgical stress.Arch Interm Med. 1987; 147: 1273
- Corticosteroids.in: Chernow B. Holasay J.W. Zaloga C.P. The Pharmacological Approach to the Critically 111 Patient. ed 2. William & Wilkins, Baltimore1988: 559
- Mechanism of action of aldosterone.in: DeGroot L.J. Besser G.N. Cahill G.F. Endocrinology. ed 2. WB Saunders, Philadelphia1989: 1572
- Corticosteroids in homeostasis.Acta Physiol Scand. 1989; 136 (S27): S583
- Adrenocortical dysfunction in acute medical illness.Crit Care Med. 1986; 14: 789
- Variable adrenocortical function in acute medical illness.Crit Care Med. 1985; 13: 477
- Electrolyte metabolism.in: DeGroot L.J. Besser G.M. Cahill G.F. Endocrinology. ed 2. WB Saunders, Philadelphia1989: 1582
- Mechanism of cortisol.in: DeGroot L.J. Besser G.M. Cahill G.F. Endocrinology. ed 2. WB Saunders, Philadelphia1989: 1557
- The dissociation of renin and aldosterone during critical illness.J Clin Endocrinol Metab. 1987; 64: 592
- Adrenal pathology in the acquired immune deficiency syndrome.Am J Clin Pathol. 1985; 84: 594
- Natural history of pituitary-adrenal recovery following long-term suppression with corticosteroids.J Clin Endocrinol. 1965; 25: 11
- Hydrocortisone secretion in man: Studies of adrenal vein blood.Surgery. 1957; 42: 195
- Assessment of the hypothalamic-pituitary-adrenal (HPA) axis dysfunction: Comparison of ACTH stimulation, insulin — hypoglycemia and metyrapone.J Endocrinol Invest. 1988; 11: 769
- Direct measurement of adrenal secretion during operative trauma and convalescence.Surgery. 1962; 52: 174
- Spectrum of serum cortisol response to ACTH in ICU patients. Correlation with degree of illness and mortality.Chest. 1987; 92: 292
- Corticosteroids and infection.Adv Intern Med. 1958; 9: 45
- Nutrition in the intensive care patient.Crit Care Clin. 1987; 3: 1
- Salivary cortisol measurement: A practical approach to assess pituitary-adrenal function.J Clin Endocrinol Metab. 1988; 66: 343
- Heparin-induced hypoaldosteronism.JAMA. 1981; 246: 2189
- Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone infusion.Ann Interm Med. 1953; 39: 116
- Effects of auriculin (atrial natriuretic factor) on blood pressure, renal function, and the renin-aldosterone system in dogs.Am J Med. 1984; 77: 1069
- Septicemic adrenal hemorrhage.Am J Dis Child. 1963; 105: 346
- Secretion and metabolism of the corticosteroids and adrenal function and testing.in: DeGroot L.J. Besser G.M. Cahill G.F. Endocrinology. ed 2. WB Saunders, Philadelphia1989: 1610
- Molecular genetics of corticosteroid action.Am Rev Respir Lie. 1990; 141: 311
- Diagnosis and treatment of primary aldosteronicm and isolated hypoaldoseeronism.in: DeGroot L.J. Besser G.M. Cahill G.F. ei a.l. Endocrinology. ed 2. WE Saunders, Philadelphia1989: 1708
- Adrenocortical function m acquired immunodeficiency syndrome.J Clin Endocrinol Metab. 1987; 65: 482
- The metabolism and mechanism of action of aldosterone.Endocrinol Rev. 1981; 2: 234
- Physiological functions of glucocorticoids in stress and their relation to pharmacological actions.Endrocrinol Rev. 1984; 5: 25
- Glucocorticoid receptors and actions.Am Rev Respir Dis. 1990; 141: S2
- A method for the simultaneous determination of the secretion rates of cortisol, 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, and aldosterone.J Clin Endocrinol Metab. 1969; 29: 514
- Evidence of adrenocortical adaptation to severe illness.J Clin Endocrinol Metab. 1985; 60: 947
- The role oflipocortin in corticosteroid actions.Am Rev Respir Dis. 1990; 141: S18
- Renin-angiotensin II-aldosterone and ACTH cortisol control during acute hypoxemia and exercise in patients with chronic obstructive pulmonary disease.Am Rev Respir Dis. 1986; 133: 396
- Bilateral massive adrenal hemorrhage: Early recognition and treatment.Ann Intern Med. 1989; 110: 227
- Plasma cortisol levels in patients with septic shock.Crit Care Med. 1990; 18: 259
- Variations in adrenocortical responsiveness during severe bacterial infections.Ann Surg. 1977; 186: 29
- Adrenal insufficiency from bilateral adrenal hemorrhage.Mayo Clin Proc. 1990; 65: 664
- The use of ketoconazole as an inhibitor of steroid production.N Engl J Med. 1987; 317: 812
- Pituitary adrenal recovery following short-term suppression with corticosteroids.Am J Med. 1979; 66: 910
- Action of corticosteroids on β-adrenergic receptors.Am Rev Respir Dis. 1990; 141: S31
- Aldosterone secretion in steroid-treated patients with adrenal suppression.Lancet. 1971; 1: 623
- ACTH stimulation of aldosterone secretion in normal subjects and in patients with chronic adrenocortical insufficiency.J Clin Endocrinol Met. 1967; 27: 568
- Disorders of the adrenal cortex.in: Wyngaarden J.B. Smith L.H. Cecil’s Textbook of Medicine. ed 17. WB Saunders, Philadelphia1985: 1300
- Effects of high-dose glucocorticoid therapy on mortality of patients with clinical signs of systemic sepsis.N Engl J Med. 1987; 317: 659
- Inhibition of adrenal steroidogenesis by the anesthetic etomidate.N Engl J Med. 1984; 310: 1415
- The metabolic response to trauma and sepsis.in: DeGroot LJ Besser GM Cahill GF Endocrinology. ed 2. WB Saunders, Philadelphia1989: 2367
- Preoperative endocrine and metabolic considerations.Med Clin North Am. 1979; 63: 1321
- Steroid receptor regulated transcription of specific genes and gene networks.Ann Rev Genetics. 1985; 19: 209
Article info
Identification
Copyright
© 1991 Elsevier Inc. Published by Elsevier Inc. All rights reserved.