title: Adrenal failure in the critically ill.
abstract: Three critically ill patients suffered multiple organ failure secondary to sepsis. Despite adequate supportive therapy and appropriate antibiotic cover, they failed to improve and required inappropriate inotrope support. They had not been treated with steroids or other drugs known to suppress adrenal function. Adrenal insufficiency was suspected. A random cortisol concentration and a short synacthen test demonstrated concentrations below the range expected in all three cases. High-dose steroid therapy was commenced with marked improvement in the short-term. However, in each case sepsis eventually caused death.
authors.affiliation: Department of Anaesthesia and Intensive Care, Beaumont Hospital, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Duggan
authors.forename: I
authors.initials: I
authors.lastname: Browne
authors.forename: C
authors.initials: C
authors.lastname: Flynn
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis*; D000324:Adrenocorticotropic Hormone; D000368:Aged; D003422:Critical Care; D004361:Drug Tolerance; D004837:Epinephrine / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000209:etiology; D012772:Shock, Septic / Q000150:complications; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D000324:Adrenocorticotropic Hormone; D004837:Epinephrine