Adrenocortical (dys)function in septic shock – A sick eudrenal state

Venkatesh, Balasubramanian and Cohen, Jeremy (2011) Adrenocortical (dys)function in septic shock – A sick eudrenal state. Best Practice and Research Clinical Endocrinology and Metabolism, 25 5: 719-733. doi:10.1016/j.beem.2011.04.007


Author Venkatesh, Balasubramanian
Cohen, Jeremy
Title Adrenocortical (dys)function in septic shock – A sick eudrenal state
Journal name Best Practice and Research Clinical Endocrinology and Metabolism   Check publisher's open access policy
ISSN 1878-1594
Publication date 2011-10
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.beem.2011.04.007
Volume 25
Issue 5
Start page 719
End page 733
Total pages 15
Place of publication Oxford, United Kingdom
Publisher Bailliere Tindall
Collection year 2012
Language eng
Abstract A central feature of the endocrine pathophysiology of septic shock is thought to be the existence of adrenal dysfunction. Based on changes in glucocorticoid secretion and responsiveness, protein binding, and activity. These changes have been described by the terms “Relative Adrenal Insufficiency” (RAI), or “Critical Illness Related Corticosteroid Insufficiency” (CIRCI), and form part of the rationale for trials of glucocorticoid treatment in septic shock.5 Diagnostic criteria for these conditions have been based on plasma cortisol profiles and have proven notoriously difficult to establish. The uncertainty in this area arises from the inability of current tests to clearly identify who is truly glucocorticoid “deficient” at a cellular level, and hence who requires supplemental glucocorticoid administration. Emerging data suggest that there may be abnormalities in the tissue activity of glucocorticoids in patients with severe sepsis and plasma profiles may not be reliable indicators of tissue glucocorticoid activity, We put forward an alternative point of view, that is the spectrum of adrenocortical dysfunction in sepsis – plasma and tissue, can be grouped under the umbrella of a “sick euadrenal syndrome” rather than an adrenocortical insufficiency.
Keyword Adrenal
Septic shock
Free cortisol
11-betahydroxysteroid dehydrogenase
Sick euadrenal
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Fri, 23 Sep 2011, 16:46:30 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH