Relative adrenal failure in the ICU: an identifiable problem requiring treatment.
Critically ill patients at some stage may develop adrenal insufficiency (AI). This article reviews the mechanisms, diagnosis criteria, consequences, and treatment of AI in various ICU conditions. Glucocorticoid insufficiency may be related to a decrease in glucocorticoid synthesis (ie, adrenal insufficiency) or to a reduced delivery of glucocorticoid to target tissues and cells. Diagnosis relies on clinical suspicion and ACTH test results. The length of cortisol replacement therapy should be at least 7 days and the adjunction of fludrocortisone is recommended.
Gonzalez
Hélène
H
Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
Nardi
Olivier
O
Annane
Djillali
D
D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D016638:Critical Illness; D005938:Glucocorticoids / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000502:physiology; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D013312:Stress, Physiological / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000503:physiopathology
D005938:Glucocorticoids; D006854:Hydrocortisone