Adrenal insufficiency during critical illness was first described by Hans Selye in 1949, in which he described a stress response that occurs when an event threatens an organism’s well-being. Since that time, adrenal insufficiency has been well recognized outside of the critical care setting and is defined as a failing in cortisol production resulting in low baseline cortisol levels, with no response to the ACTH stimulation test. More recently it has been recognized that a transient state of relative adrenal insufficiency occurs in patients within the critical care setting. The reported evidence of this critical illness corticosteroid insufficiency (CIRC) in critically ill patients varies widely (0–77%), depending on the population of patients studied and the diagnostic criteria. In addition, the underlying mechanism surrounding the disorder remains poorly understood.
KeywordsAdrenal insufficiency Cortisol levels ACTH stimulation test Corticosteroids
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