| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Department of Critical Care Medicine (Dr. Marik), University of Pittsburgh, Pittsburgh, PA; and Methodist Research Institute (Dr. Zaloga), Respiratory and Critical Care Consultants, and Department of Medicine of Indiana University School of Medicine, Indianapolis, IN.
Correspondence to: Paul Marik, MD, FCCP, Department of Critical Care, University of Pittsburgh Medical School, 640A Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261; e-mail: pmarik{at}zbzoom.net
Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and management of HPA dysfunction in the critically ill.
Key Words: adrenal axis • adrenal corticotropin hormone • adrenal insufficiency • cortisol • critical care • glucocorticoid receptors • hypothalamic-pituitary • ICU • sepsis • systemic inflammatory response syndrome
This article has been cited by other articles:
|
|
 |
|
  Z. Thomas and G. L Fraser An Update on the Diagnosis of Adrenal Insufficiency and the Use of Corticotherapy in Critical Illness Ann. Pharmacother., September 1, 2007; 41(9): 1456 - 1465. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Vanhorebeek, R. P. Peeters, S. Vander Perre, I. Jans, P. J. Wouters, K. Skogstrand, T. K. Hansen, R. Bouillon, and G. Van den Berghe Cortisol Response to Critical Illness: Effect of Intensive Insulin Therapy J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3803 - 3813. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. E. Marik, D. Annane, C. L. Sprung, W. Arlt, D. Keh, and for the International Task Force on the Diagnoses Using Corticosteroids in Intensive Care Arch Surg, September 1, 2006; 141(9): 946 - 947. [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Szumita, B. C. Greenwood, C. M. Lowry, and M. E. Wechsler Using the high-dose corticotropin test to diagnose relative adrenal insufficiency in vasopressor-dependent septic shock Am. J. Health Syst. Pharm., March 1, 2006; 63(5): 466 - 471. [Full Text] [PDF]
|
|
|
|
 |
|
 C.-J. Huang and H.-C. Lin Association between Adrenal Insufficiency and Ventilator Weaning Am. J. Respir. Crit. Care Med., February 1, 2006; 173(3): 276 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bernard, J. Outtrim, D. K. Menon, and B. F. Matta Incidence of adrenal insufficiency after severe traumatic brain injury varies according to definition used: clinical implications Br. J. Anaesth., January 1, 2006; 96(1): 72 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. E. Widmer, J. J. Puder, C. Konig, H. Pargger, H. R. Zerkowski, J. Girard, and B. Muller Cortisol Response in Relation to the Severity of Stress and Illness J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4579 - 4586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Y. Rady, D. J. Johnson, B. Patel, J. Larson, and R. Helmers Cortisol Levels and Corticosteroid Administration Fail to Predict Mortality in Critical Illness: The Confounding Effects of Organ Dysfunction and Sex Arch Surg, July 1, 2005; 140(7): 661 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Cocanour Cortisol Levels and Corticosteroid Administration Fail to Predict Mortality in Critical Illness--Invited Critique Arch Surg, July 1, 2005; 140(7): 669 - 669. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Ciesla, E. E. Moore, J. L. Johnson, J. M. Burch, C. C. Cothren, and A. Sauaia A 12-Year Prospective Study of Postinjury Multiple Organ Failure: Has Anything Changed? Arch Surg, May 1, 2005; 140(5): 432 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. F Kozyra, R. S Wax, and L. D Burry Can 1 {micro}g of Cosyntropin Be Used to Evaluate Adrenal Insufficiency in Critically Ill Patients? Ann. Pharmacother., April 1, 2005; 39(4): 691 - 698. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. N Bower and L. J Oyen Interaction Between Dexamethasone Treatment and the Corticotropin Stimulation Test in Septic Shock Ann. Pharmacother., February 1, 2005; 39(2): 335 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Wood, B. N. Becker, J. G. McCartney, A. M. D'Alessandro, and D. B. Coursin Care of the Potential Organ Donor N. Engl. J. Med., December 23, 2004; 351(26): 2730 - 2739. [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Magill, T. Puthanakit, S. M. Swoboda, K. A. Carson, R. Salvatori, P. A. Lipsett, and C. W. Hendrix Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients Antimicrob. Agents Chemother., July 1, 2004; 48(7): 2471 - 2476. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Xu, A. J. Johnson, D. Liggitt, and M. J. Bevan Cellular and Humoral Immunity against Vaccinia Virus Infection of Mice J. Immunol., May 15, 2004; 172(10): 6265 - 6271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. D Burry and R. S Wax Role of Corticosteroids in Septic Shock Ann. Pharmacother., March 1, 2004; 38(3): 464 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Steingrub, P. E. Marik, and G. P. Zaloga Steroids and Drotrecogin Alfa (Activated) for Severe Sepsis Chest, November 1, 2003; 124(5): 2033 - 2034. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
