| Title | "Relative" Adrenal Insufficiency in Critical Illness. | | Author(s) | Fleseriu M, Loriaux DL | | Institution | Department of Medicine, Oregon Health & Science University, Portland, OR Department of Neurological Surgery, Oregon Health & Science University, Portland, OR. | | Source | Endocr Pract 2009 Jul 20.:1-27. | | Abstract | Objective: Given current understanding we make recommendations on how to approach the problem of relative adrenal insufficiency (RAI) in the Intensive Care Unit (ICU).
Methods: We examine historical data that supports the traditional concepts of adrenal insufficiency (AI) and the idea that the increase in cortisol secretion during stress is needed to survive the stress. Controversial use of glucocorticoid (GC) treatment in patients with sepsis and septic shock in the ICU and thus survival benefit is also briefly discussed.
Results: Over the past decade, the concept of RAI as the failure of cortisol secretion to increase in response to stress to sustain the patient through that stress has gained strength. In some studies, it has been suggested that as many as 75% of patients in an ICU setting have RAI. Experimental support for the concept is not possible as there is no clinically useful laboratory measure of GC action. Therefore, diagnosis is generally based on interpretation of the Cortrosyn(R) stimulation test (CST).
Conclusion: The best clinical judgment should always guide interpretation of any test results and one should avoid sharp categorization of patients on the basis of a single cut-off. All in all, the concept of RAI has no clinical utility. In these cases, GC administration adds cost without benefit and with increased risk. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19625244 |
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