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Adrenal insufficiency with acute crisis is a cause of shock in critically ill patients that may be underdiagnosed. Adrenal insufficiency may result from adrenal, pituitary, or hypothalamic disorders. Medications may also contribute to adrenal insufficiency. Critical illness-related corticosteroid insufficiency (CIRCI) is a relative adrenal insufficiency in which cortisol levels are inadequate for the acute critical illness and is discussed in Chap. 57. Diagnosis of adrenal insufficiency and differentiation of its various etiologies can be accomplished by measuring serum cortisol, ACTH levels, and by challenging the patient with exogenous adrenocorticotropic hormone (ACTH). Glucocorticoid replacement therapy is the mainstay of treatment, along with fluid resuscitation and supportive care. Salt repletion and glucose supplementation may be required, depending on the etiology of adrenal insufficiency. Mineralocorticoid replacement may also be necessary for primary adrenal insufficiency.
KeywordsAdrenal insufficiency Steroid replacement ACTH stimulation testing Addisonian crisis
- 10.Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937–49.CrossRefGoogle Scholar
- 21.Schimmer BP, Funder JW. Adrenal steroids, and pharmacology of the adrenal cortex. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s: the pharmacological basis of therapeutics. 12th ed. New York, NY: McGraw-Hill Education; 2011.Google Scholar