Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit

In critically ill patients, activation of the hypothalamus-pituitary-adrenal (HPA) axis with the production of cortisol is crucial for survival under conditions of physiologic stress. The increase in cortisol production results in several important effects on metabolic, cardiovascular and immune aim...

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Main Author:	Mat Nor, Mohd Basri
Format:	Article
Language:	English
Published:	Malaysian Society of Anaesthesiologists 2014
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/61858/ http://irep.iium.edu.my/61858/ http://irep.iium.edu.my/61858/1/61858_Diagnosing%20and%20treatment%20of%20adrenocortical.pdf

id	iium-61858
recordtype	eprints
spelling	iium-618582018-02-27T02:05:43Z http://irep.iium.edu.my/61858/ Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit Mat Nor, Mohd Basri R Medicine (General) In critically ill patients, activation of the hypothalamus-pituitary-adrenal (HPA) axis with the production of cortisol is crucial for survival under conditions of physiologic stress. The increase in cortisol production results in several important effects on metabolic, cardiovascular and immune aimed at restoring homeostasis during stress. However, in critical illness, HPA axis undergoes complex changes and the optimum level of plasma cortisol is unclear. In addition to activation of the HPA axis, cortisol metabolism and function may be significantly altered by various aspects of critical illness. There are conditions in which cortisol concentration cannot increase appropriately to meet demand. Assessment of cortisol activity in this group of patients is also difficult because laboratory assays of total plasma cortisol concentration and response to adrenocorticotropic hormone (ACTH) stimulation do not consistently reflect corticosteroid deficient at cellular level. It has been suggested that during critical illness, plasma cortisol concentration poorly reflect the glucocorticoid activity at target tissues. Venkatesh et al. has postulated that the spectrum of adrenocortical dysfunction in sepsis (from plasma to tissue) should be grouped under ‘sick euadrenal syndrome’ rather than an adrenocortical insufficiency. Malaysian Society of Anaesthesiologists 2014 Article PeerReviewed application/pdf en http://irep.iium.edu.my/61858/1/61858_Diagnosing%20and%20treatment%20of%20adrenocortical.pdf Mat Nor, Mohd Basri (2014) Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit. Malaysian Society of Anaesthesiologists Yearbook 2013/2014, 2013/2014. pp. 60-67. http://www.msa.net.my/index.cfm?&menuid=52&parentid=55
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Mat Nor, Mohd Basri Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
description	In critically ill patients, activation of the hypothalamus-pituitary-adrenal (HPA) axis with the production of cortisol is crucial for survival under conditions of physiologic stress. The increase in cortisol production results in several important effects on metabolic, cardiovascular and immune aimed at restoring homeostasis during stress. However, in critical illness, HPA axis undergoes complex changes and the optimum level of plasma cortisol is unclear. In addition to activation of the HPA axis, cortisol metabolism and function may be significantly altered by various aspects of critical illness. There are conditions in which cortisol concentration cannot increase appropriately to meet demand. Assessment of cortisol activity in this group of patients is also difficult because laboratory assays of total plasma cortisol concentration and response to adrenocorticotropic hormone (ACTH) stimulation do not consistently reflect corticosteroid deficient at cellular level. It has been suggested that during critical illness, plasma cortisol concentration poorly reflect the glucocorticoid activity at target tissues. Venkatesh et al. has postulated that the spectrum of adrenocortical dysfunction in sepsis (from plasma to tissue) should be grouped under ‘sick euadrenal syndrome’ rather than an adrenocortical insufficiency.
format	Article
author	Mat Nor, Mohd Basri
author_facet	Mat Nor, Mohd Basri
author_sort	Mat Nor, Mohd Basri
title	Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
title_short	Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
title_full	Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
title_fullStr	Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
title_full_unstemmed	Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
title_sort	diagnosing and treatment of adrenocortical insufficiency in the intensive care unit
publisher	Malaysian Society of Anaesthesiologists
publishDate	2014
url	http://irep.iium.edu.my/61858/ http://irep.iium.edu.my/61858/ http://irep.iium.edu.my/61858/1/61858_Diagnosing%20and%20treatment%20of%20adrenocortical.pdf
first_indexed	2023-09-18T21:27:45Z
last_indexed	2023-09-18T21:27:45Z
_version_	1777412305607196672

Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit

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