Adrenal insufficiency in critical patients: New ethiopathogenic concepts and therapeutic implications

• Published in: Endocrinologia, diabetes y nutricion Vol. 64; no. 10; p. 557
• Main Authors: Mateos Moreno, Laura, Palacios García, Nuria, Estrada García, Francisco Javier
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-12-2017
• Subjects: Acute Disease; Adrenal Cortex Hormones - therapeutic use; Adrenal Insufficiency - diagnosis; Adrenal Insufficiency - etiology; Adrenal Insufficiency - physiopathology; Adrenal Insufficiency - therapy; Chronic Disease; Critical Illness; Disease Progression; Hemodynamics; Humans; Hydrocortisone - metabolism; Hypothalamo-Hypophyseal System - physiopathology; Inflammation - etiology; Inflammation - physiopathology; Models, Biological; Pituitary-Adrenal System - physiopathology; Stress, Physiological; Metabolismo del cortisol; Adrenal insufficiency; Insuficiencia suprarrenal; Cortisol metabolism; Enfermo crítico; Critical patient
• ISSN: 2530-0172
• DOI: 10.1016/j.endinu.2017.09.004

Recently, there have been advances in understanding of the changes that occur in the hypothalamic-pituitary-adrenal axis during the different stages of critical disease. Such advances have led to a paradigm change, so that the aforementioned adaptations are no longer considered the result of adrenal axis activation, but a consequence of decreased cortisol metabolism illness. Knowledge of this new pathophysiological bases should lead to reconsider the diagnosis and treatment of adrenal insufficiency in critically ill patients, a condition poorly understood to date.