The clinical importance of adrenal insufficiency in acute hepatic dysfunction

@article{Harry2002TheCI,
  title={The clinical importance of adrenal insufficiency in acute hepatic dysfunction},
  author={Rachael Harry and Georg Auzinger and Julia A. Wendon},
  journal={Hepatology},
  year={2002},
  volume={36}
}
Acute liver failure and septic shock share many clinical features, including hyperdynamic cardiovascular collapse. Adrenal insufficiency may result in a similar cardiovascular syndrome. In septic shock, adrenal insufficiency, defined using the short synacthen test (SST), is associated with hemodynamic instability and poor outcome. We examined the SST, a dynamic test of adrenal function, in 45 patients with acute hepatic dysfunction (AHD) and determined the association of these results with… 
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References

SHOWING 1-10 OF 21 REFERENCES
Impaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserve.
TLDR
In septic shock, impaired adrenal function reserve may partly be accounted for by the depressed pressor sensitivity to noradrenaline, which may be substantially improved by physiological doses of hydrocortisone.
Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study.
TLDR
Infusion of stress doses of hydrocortisone reduced the time to cessation of vasopressor therapy in human septic shock and was associated with a trend to earlier resolution of sepsis-induced organ dysfunctions.
Comparative studies on adrenal cortical function and cortisol metabolism in healthy adults and in patients with shock due to infection.
TLDR
Investigations in the laboratory have shown that shock produced in dogs by endotoxins of gram-negative bacteria was accompanied by an elevation of the concentration of cortisol in the plasma, and the output in adrenal venous blood rose abruptly immediately after the injection of endotoxin.
Reversal of late septic shock with supraphysiologic doses of hydrocortisone.
TLDR
Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival.
A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin.
TLDR
The data suggest that a short corticotropin test has a good prognostic value and could be helpful in identifying patients with septic shock at high risk for death.
Plasma cortisol levels in patients with septic shock.
TLDR
It is concluded that plasma cortisol concentrations are increased in patients with septic shock, but that the degree of increase is variable and may be related to type of infection, length of time in shock, and BP at the time of blood sampling.
RE‐EVALUATION OF THE CLINICAL VALUE OF THE 30 MIN ACTH TEST IN ASSESSING THE HYPOTHALAMIC‐PITUITARY‐ADRENOCORTICAL FUNCTION
TLDR
It is concluded that the 30 min ACTH test is reliable for assessing integrated hypothalamic‐pituitary‐adrenal function (except shortly after acute ACTH deprivation).
A simplified acute physiology score for ICU patients
TLDR
The simplified acute physiology score (SAPS), evaluated in 679 consecutive patients admitted to eight multidisciplinary referral ICUs in Francece, was a simpler and less time-consuming method for comparative studies and management evaluation between different ICUs.
...
1
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3
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