Adrenal insufficiency in the critically ill: a new look at an old problem.

@article{Marik2002AdrenalII,
  title={Adrenal insufficiency in the critically ill: a new look at an old problem.},
  author={Paul Ellis Marik and Gary P. Zaloga},
  journal={Chest},
  year={2002},
  volume={122 5},
  pages={
          1784-96
        }
}
Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and… 
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Highly Influential Citations
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Citation Type

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  • P. Marik
  • Medicine, Biology
    Current opinion in critical care
  • 2007
Purpose of reviewAdrenal insufficiency is being diagnosed with increasing frequency in critically ill patients. There exists, however, much controversy in the literature as to the nature of this…
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A lack of consensus is found within the pediatric field as to the optimal approach to CIRCI, and an international task force is called for to establish unified guidelines.
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This review illustrates the complexity and diversity of pathophysiological changes in glucocorticoid secretion, metabolism, and action and how these are affected by various types of illness and gives guidance on corticosteroid replacement regimens based on current published literature.
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The concept of adrenal insufficiency and the role it may play in a pediatric septic shock are reviewed and the latest recommendations about steroid use in Pediatrics are summarized.
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TLDR
This is the first report of changes consistent with acquired RAI in a cat with critical illness, and treatment with exogenous low-dose glucocorticoids in addition to standard therapies resulted in rapid hemodynamic and clinical improvement.
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