title: Suspected adrenal insufficiency in critically ill burned patients: etomidate-induced or critical illness-related corticosteroid insufficiency?-A review of the literature.
abstract: Adrenal insufficiency (AI), whether etomidate-induced or secondary to critical illness-related corticosteroid insufficiency (CIRCI), is a common and under appreciated problem in the intensive care unit intensive care unit (ICU). However, AI is often difficult to identify and diagnose in the critically ill. The pathophysiology and ideal management of etomidate-induced AI and CIRCI, especially in burn patients, is unknown. Many studies, however, have examined the prevalence of and risk factors for developing AI in critically ill populations as well as the effect of AI on morbidity and mortality. Observing a seemingly increased number of patients with suspected AI in our burn ICU, we sought to evaluate and summarize the current literature relating to adrenal insufficiency in the critically ill. We performed an electronic literature search on the PubMed and Ovid Medline databases using the key words "etomidate," "adrenal insufficiency," "CIRCI," and "burn injury." Relevant studies from the current burn and ICU era were selected to be included in this review of the literature. Among the critically ill, burn patients are at increased risk for developing adrenal insufficiency and the risk is greatest for elderly patients with large burns and inhalation injury. Both CIRCI and etomidate-induced AI are associated with high morbidity and mortality, therefore avoiding preventable causes of AI, such as choosing alternatives to etomidate for rapid sequence intubation (RSI) in the severely burn injured patient should be encouraged. Further research is indicated to investigate the biological relationship between AI and associated morbidity and mortality, whether etomidate-induced or secondary to critical illness; as well as how best to identify and diagnose patients with suspected adrenal insufficiency in the burn intensive care unit.
authors: From the *Loyola Burn Center and Department of Surgery, Loyola University Medical Center, Maywood, Illinois; and †Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois.
authors: Michael J
authors: MJ
authors: Mosier
authors: Alaina M
authors: AM
authors: Lasinski
authors: Richard L
authors: RL
authors: Gamelli
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects; D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002056:Burns / Q000150:complications* / Q000453:epidemiology*; D016638:Critical Illness; D005045:Etomidate / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units
chemical_list: D018686:Anesthetics, Intravenous; D005045:Etomidate