Evidence of altered cortisol metabolism in critically ill patients: a prospective study

Venkatesh, Balasubramanian; Cohen, Jérémy; Hickman, Ingrid J.; Nisbet, Janelle; Thomas, Peter D. G.; Ward, Greg; Hall, Jeremy Peter; Prins, Johannes B.

doi:10.1007/s00134-007-0727-7

Cited by 48 publications

(36 citation statements)

References 43 publications

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“…Fludrocortisone 14]. One study noted that the 11b-hydroxysteroid dehydrogenase type II enzyme activating cortisol is upregulated in certain conditions such as sepsis, and thus prevents its binding to mineralocorticoid receptors [22]. A review of FLU in critically ill adults noted a significant decrease in mortality, with 74% of patients in the HC alone group dying compared with 46% of patients in the HC ?…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of adding fludrocortisone to a hydrocortisone-based shock protocol in hypotensive critically ill children

2010

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Overall, addition of FLU in children with SIRS was not associated with decreased vasopressor duration or vasopressor score. However, HC + FLU was associated with shorter duration of NE support in the septic subgroup. Hypokalemia was a frequent adverse finding with HC + FLU (p = 0.05). Use of FLU should be considered in further studies evaluating the role of steroids in refractory pediatric septic shock.

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Section: Discussionmentioning

confidence: 99%

Clinical effects of adding fludrocortisone to a hydrocortisone-based shock protocol in hypotensive critically ill children

2010

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“…Experimental data and in vivo studies suggest that, during septic shock, inflammatory mediators like TNF and interleukins activate 11B--HSD1, increasing cortisolemia (15).…”

Section: Physiopathology Of Adrenal Insufficiency In Critical Care Pamentioning

confidence: 99%

“…Nine years later, another trial analyzed this hypothesis (15). This trial was designed to identify factors associated with mortality in critical care patients, with special attention to cortisol levels and cortisol variation.…”

Section: High Dose Cortrosyn Test (250 μG)mentioning

confidence: 99%

Diagnosis of adrenal failure in critically ill patients

Moraes

Czepielewski

Friedman

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYIn the last two decades there was important evolution on the knowledge of the function of the hypothalamic-pituitary-adrenal axis. In the last decade, the expression "relative adrenal insufficiency" (RAI) was created, and more recently "critical illness-related corticosteroid insufficiency" (CIRCI) was used to designate those patients in which cortisol production was not sufficiently increased in stress situations. Patients with CIRCI have elevated hospital morbidity and mortality. Currently, there is a wide discussion about diagnostic criteria for this dysfunction. Besides basal cortisol, some publications now study the role of other tests, such as cortrosyn test − either in low (1 μg) or high doses (250 μg); free cortisol, salivary cortisol, metyrapone test and others. With this review, we aimed at summarizing the results of the most influent papers that intended to define diagnostic criteria for CIRCI. We also suggest an approach for CIRCI diagnosis and make it clear that the decision about steroid therapy in septic shock patients is matter apart from RAI. Arq Bras Endocrinol Metab. 2011;55(5):295-302 Keywords Adrenal insufficiency; sepsis; septic shock; cortrosyn; steroid therapy; CIRCI (critical illness-related corticosteroid insufficiency); RAI (relative adrenal insufficiency) SUMÁRIO Nas últimas décadas, houve uma importante evolução no conhecimento sobre a função do eixo hipotálamo-pituitária-adrenal. Na última década, foi cunhada a expressão "insuficiência adrenal relativa" (IAR) e, mais recentemente, a expressão "insuficiência adrenal relacionada à doença grave" (CIRCI) foi utilizada para designar aqueles pacientes nos quais a produção de cortisol não era suficientemente elevada em situações de estresse. Pacientes com CIRCI apresentam elevada morbidade e mortalidade em hospitais. Atualmente, há uma ampla discussão sobre os critérios de diagnóstico para essa desordem. Além do cortisol basal, algumas publicações analisaram o papel de outros testes, tais como o teste de estímulo com ACTH (cortrosina), com doses baixas (1 mg) ou altas (250 mg), cortisol livre, cortisol salivar, teste da metirapona e outros. O objetivo desta revisão foi resumir os resultados dos artigos mais importantes que buscaram definir os critérios de diagnóstico para a CIRCI. Também sugerimos uma abordagem para o diagnóstico da CIRCI e deixamos claro que a decisão sobre a terapia com esteroides em pacientes em choque séptico é uma questão separada da IAR. Arq Bras Endocrinol Metab. 2011;55(5):295-302 Descritores Insuficiência adrenal; sepse; choque séptico; cortrosina; terapia com esteroides; CIRCI (insuficiência adrenal relacionada à doença grave); IAR (insuficiência adrenal relativa)

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“…Moreover, reduced cortisol breakdown contributed to hypercortisolemia and hence ACTH suppression [20]. Other studies have focused on the tissue and cellular adaptation during stress, including measurement of the tissue cortisol concentration [21] and its activity [22,23]. The activation of the HPA axis during stress is depicted in figure 1.…”

Section: The Hpa Axis During Acute Illnessmentioning

confidence: 99%

Critical Illness-Related Corticosteroid Insufficiency in Children

Levy‐Shraga

Pinhas‐Hamiel²

2013

Horm Res Paediatr

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Adequate adrenocortical function is essential for survival in critical illness. Most critically ill patients display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic-pituitary-adrenal axis and is considered to be a homeostatic adaptation. However, many critically ill patients have ‘relative' or ‘functional' adrenal insufficiency, which is characterized by an inadequate production of cortisol in relation to an increased demand during periods of severe stress. Recently, the term ‘critical illness-related corticosteroid insufficiency' (CIRCI) was coined. CIRCI occurs as a result of a decrease in adrenal steroid production or tissue resistance to glucocorticoids. An international task force of the American College of Critical Care Medicine issued recommendations for the diagnosis and management of this condition in adult patients. We review the prevalence, diagnosis, and therapeutic approach to adrenal insufficiency in critically ill children. We found a lack of consensus within the pediatric field as to the optimal approach to CIRCI, and call for an international task force to establish unified guidelines.

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Evidence of altered cortisol metabolism in critically ill patients: a prospective study

Cited by 48 publications

References 43 publications

Clinical effects of adding fludrocortisone to a hydrocortisone-based shock protocol in hypotensive critically ill children

Clinical effects of adding fludrocortisone to a hydrocortisone-based shock protocol in hypotensive critically ill children

Diagnosis of adrenal failure in critically ill patients

Critical Illness-Related Corticosteroid Insufficiency in Children

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