Journal
CHEST
Volume 122, Issue 5, Pages 1784-1796Publisher
ELSEVIER SCIENCE BV
DOI: 10.1378/chest.122.5.1784
Keywords
adrenal axis; adrenal corticotropin hormone; adrenal insufficiency; cortisol; critical care; glucocorticoid receptors; hypothalamic-pituitary; ICU; sepsis; systemic inflammatory response syndrome
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Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and management of HPA dysfunction in the critically ill.
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