Normal adrenocortical function on initial testing in the intensive care unit: not a long-term warranty.
There has been a lot of debate about the concept of relative adrenocortical insufficiency (often defined as a reduced response to corticotropin) as a pathophysiological explanation of steroid effects in septic shock. Less is known about the prevalence of absolute adrenocortical insufficiency based on more usual definitions (low baseline and corticotropin stimulated cortisol). A study by Wu and colleagues provides convincing evidence that critically ill patients could evolve from a normal adrenal status towards very low cortisol levels within a few days. Although the exact consequences of these findings deserve more investigation, adrenal testing should not be omitted in patients not improving their hemodynamic status.
Bollaert
Pierre-Edouard
PE
D000302:Adrenal Cortex / Q000502:physiology*; D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis; D003955:Diagnostic Tests, Routine / Q000592:standards* / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000639:trends; D013995:Time