Critical illness-related corticosteroid insufficiency overview
|
Critical illness-related corticosteroid insufficiency Microchapters |
|
Differentiating Critical illness-related corticosteroid insufficiency from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Critical illness-related corticosteroid insufficiency overview On the Web |
|
American Roentgen Ray Society Images of Critical illness-related corticosteroid insufficiency overview |
|
FDA on Critical illness-related corticosteroid insufficiency overview |
|
CDC on Critical illness-related corticosteroid insufficiency overview |
|
Critical illness-related corticosteroid insufficiency overview in the news |
|
Blogs on Critical illness-related corticosteroid insufficiency overview |
|
Directions to Hospitals Treating Critical illness-related corticosteroid insufficiency |
|
Risk calculators and risk factors for Critical illness-related corticosteroid insufficiency overview |
Overview
Critical illness-related corticosteroid insufficiency (CIRCI) is a form of adrenal insufficiency in critically ill patients who have blood corticosteroid levels which are inadequate for the severe stress response they experience. Combined with decreased glucocorticoid receptor sensitivity and tissue response to corticosteroids, this adrenal insufficiency constitutes a negative prognostic factor for intensive care patients.[1]
The hypothalamic-pituitary-adrenal axis (HPA axis), in which the hypothalamus and pituitary gland control adrenal secretions, undergoes profound changes during critical illness. Both very high and very low levels of cortisol have been linked to a poor outcome in intensive care patients.[2] It has been suggested that high levels could represent severe stress, whereas low levels are due to blunted cortisol production and response.[3]
CIRCI can be suspected in patients with low blood pressure (low blood pressure) despite resuscitation with intravenous fluids and vasopressor drugs.[4] The Surviving Sepsis Campaign guidelines advocate intravenous hydrocortisone only in adults with septic shock and refractory hypotension.[4] The exact definition of this condition, the best ways to test for corticoid insufficiency in critically ill patients, and the therapeutic use of (usually low doses) of corticosteroids remains a subject of debate.[5]
References
- ↑ Marik PE, Pastores SM, Annane D; et al. (2008). "Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine". Crit. Care Med. 36 (6): 1937–49. doi:10.1097/CCM.0b013e31817603ba. PMID 18496365. Unknown parameter
|month=ignored (help) - ↑ Rothwell PM, Lawler PG (1995). "Prediction of outcome in intensive care patients using endocrine parameters". Crit. Care Med. 23 (1): 78–83. PMID 8001391. Unknown parameter
|month=ignored (help) - ↑ Annane D, Sébille V, Troché G, Raphaël JC, Gajdos P, Bellissant E (2000). "A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin". JAMA. 283 (8): 1038–45. PMID 10697064. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Dellinger RP, Levy MM, Carlet JM; et al. (2008). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Crit. Care Med. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. Unknown parameter
|month=ignored (help) - ↑ Mesotten D, Vanhorebeek I, Van den Berghe G (2008). "The altered adrenal axis and treatment with glucocorticoids during critical illness". Nat Clin Pract Endocrinol Metab. 4 (9): 496–505. doi:10.1038/ncpendmet0921. PMID 18695699. Unknown parameter
|month=ignored (help)