Adrenal Insufficiency in Critically Ill Patients

Shenker, Yoram; Skatrud, James B.

doi:10.1164/ajrccm.163.7.2012022

Cited by 78 publications

(40 citation statements)

References 24 publications

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“…The present study observed dynamically and described a constellation of changes in hypopituitary-adrenal-axis hormone levels that suppose the existence of a relative adrenal insufficiency in patients with NP comparable with the hormone profile of other diseases such as severe sepsis, septic shock, and multiple organ failure (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 54%

Role of endogenous glucocorticoid metabolism in human acute pancreatitis*

Muller

Vogeser

Belyaev

et al. 2006

Critical Care Medicine

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Although an increase in adrenocorticotropic hormone levels is suggested to increase corresponding cortisol levels, cortisol levels decreased during the development of necrotizing acute pancreatitis. This phenomenon, along with the continuously decreasing corticosteroid-binding globulin levels, brings up the hypothesis of a relative adrenal insufficiency, which favors acinar cell apoptosis and hence may trigger the development of necrosis in the initial vulnerable phase of acute pancreatitis.

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Section: Discussionmentioning

confidence: 54%

Role of endogenous glucocorticoid metabolism in human acute pancreatitis*

Muller

Vogeser

Belyaev

et al. 2006

Critical Care Medicine

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“…In this study, normal rats that received 60 μg/day of ACTH for 16 weeks had a severe degree of adrenal gland haemorrhage and vacuolisation. Elevated ACTH level is postulated to increase the arterial blood flow to the adrenal glands, in excess of the venous drainage contributing to the disruption of the delicate architecture and haemorrhage (4). The usual time frame for clinical presentation with hypotension and hyponatraemia is 48–72 h as was in our case (5).…”

Section: Discussionmentioning

confidence: 67%

Bilateral adrenal gland haemorrhage: an unusual cause

Gowda

Shenoy

Malabu

et al. 2014

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryOur patient had drainage of a large amoebic liver abscess. This got complicated by a severe degree of hypotension, which required aggressive fluid resuscitation and hydrocortisone support. Computerised tomography (CT) of the abdomen revealed bilateral adrenal gland haemorrhage (BAH) resulting in primary adrenal gland failure, which was the cause for hypotension. Patient was on long-term warfarin for provoked deep vein thrombosis of lower limb, which was discontinued before the procedure. Thrombophilia profile indicated the presence of lupus anticoagulant factor with prolonged activated partial thromboplastin time (aPTT). Patient was discharged on lifelong warfarin. This case emphasises the need for strong clinical suspicion for diagnosing BAH, rare but life-threatening condition, and its association with amoebic liver abscess and anti-phospholipid antibody syndrome (APLS).Learning points Recognition of BAH as a rare complication of sepsis.APLS can rarely cause BAH.

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“…The paradox of responsiveness to low-dose glucocorticoids, despite an absence of biochemical or histologic adrenal insufficiency (postmortem examination almost never shows destruction of the adrenal on histopathology), has been explained on the basis of desensitization of glucocorticoid responsiveness at the cellular level (27,28). Even in these welldesigned and well-conducted clinical trials key issues of sample size, patient selection, concomitant treatment, and statistical analysis that can affect interpretation of the primary results have been raised (2)(3)(4).…”

Section: Discussionmentioning

confidence: 99%