Relative adrenal insufficiency in the intensive care population; background and critical appraisal of the evidence

Cohen, J and Venkatesh, B (2010) Relative adrenal insufficiency in the intensive care population; background and critical appraisal of the evidence. Anaesthesia and Intensive Care, 38 3: 425-436.


Author Cohen, J
Venkatesh, B
Title Relative adrenal insufficiency in the intensive care population; background and critical appraisal of the evidence
Journal name Anaesthesia and Intensive Care   Check publisher's open access policy
ISSN 0310-057X
1448-0271
Publication date 2010-05
Sub-type Critical review of research, literature review, critical commentary
Volume 38
Issue 3
Start page 425
End page 436
Total pages 12
Editor Neville M. Gibbs
Place of publication Melbourne, VIC, Australia
Publisher Australian Association of Anaesthetists
Collection year 2011
Language eng
Formatted abstract
Dysfunction of the hypothalamo-pituitary adrenal axis has become a central feature in descriptions of the pathophysiology of sepsis. However, despite hundreds of published articles including literature reviews and consensus statements, controversy still exists regarding the fundamental nature of the disorder and its relevance to clinical management. Often referred to as 'relative adrenal insufficiency', a recent consensus conference has proposed the alternate term 'critical illness related corticosteroid insufficiency' and suggested diagnostic criteria of a delta serum cortisol of less than 9 µg/l after adrenocorticotrophic hormone administration or a random total cortisol of under 10 µg/l.

This review attempts to establish a critical reappraisal of the evidence for the existence of relative adrenal insufficiency/critical illness related corticosteroid insufficiency in patients with sepsis and examines the background, controversies and possibilities for future research into the condition.
Keyword Adrenal insufficiency
Intensive care
Critical illness related adrenal insufficiency
11-beta-hydroxysteroid dehydrogenase type-1
Plasma-cortisol levels
Severely stressed patients
Septic shock patients
Acute-phase response
Glucocorticoid-receptor
Ill patients
Serum cortisol
Severe sepsis
Adrenocortical function
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 14 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Sun, 06 Jun 2010, 00:08:52 EST