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Pathophysiology and management of adrenal disorders in the critically ill 

Pathophysiology and management of adrenal disorders in the critically ill
Pathophysiology and management of adrenal disorders in the critically ill

Bala Venkatesh

and Jeremy Cohen

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date: 16 May 2022

The existence of the syndromes of relative adrenal insufficiency, or critical illness corticosteroid insufficiency, are debatable. In sepsis, there are alterations in plasma cortisol profiles, and corticotropin responsiveness with marked variability in responses between patients. It is probable that the spectrum of plasma and tissue glucocorticoid changes may represent a ‘sick euadrenal state’ analogous to the sick euthyroid state and may not reflect adrenocortical insufficiency. Treatment of acute adrenal crisis should not be delayed for the results of adrenal testing, and should consist of immediate supportive measures, fluid resuscitation, and high-dose intravenous glucocorticoid therapy. Admission to intensive care with a primary diagnosis of hyperadrenalism is uncommon. Patients usually present uncontrolled hypertension, electrolyte abnormalities or encephalopathy.

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