The altered adrenal axis and treatment with glucocorticoids during critical illness.
paper
Cited
Public
Unavailable
- Authors
- Mesotten, Dieter; Vanhorebeek, Ilse; Van den Berghe, Greet
- Year
- 2008
- Journal
- Nature clinical practice. Endocrinology & metabolism
- PMID
- 18695699
- DOI
- 10.1038/ncpendmet0921
Critical illness is generally hallmarked by activation of the hypothalamic-pituitary-adrenal axis. The development of very high levels of cortisol has been associated with severe illness and a raised risk of death. Likewise, a response that is inadequate relative to the degree of stress, termed relative adrenal insufficiency (also known as critical-illness-related corticosteroid insufficiency) has been associated with increased mortality. Much controversy exists with regard to the definition and biochemical testing of an adequate adrenal response to critical illness, which hampers diagnosis. High doses of glucocorticoids have been shown to have no effect in this setting and might be harmful. Moderate doses have been advocated, however, for critically ill patients with inflammatory conditions, such as acute respiratory distress syndrome and septic shock syndrome. Initial results from proof-of-concept studies were promising but thus far have not been reproduced in large, multicenter trials, although the latter were underpowered to yield definite conclusions. The role of glucocorticoid therapy in intensive care, therefore, remains uncertain. Until the debate has been settled, we recommend that use of glucocorticoid therapy in critically ill patients should continue to be based on the clinician's judgment and that routine adjuvant use should be avoided.
No figures extracted from this document.
No chunks β full text not yet ingested.
No entities extracted from this document yet.
No uploaded files.
Not in any collection.
No citations found.
In this knowledge base
| Title | Year | PMID |
|---|---|---|
| Stress-response pathways are altered in the hippocampus of chronic alcoholics. | 2013 | 23981442 |
External
| Title | Authors | Journal | Year | Link |
|---|---|---|---|---|
| Hydrocortisone combined with fludrocortisone for treatment of adults with septic shock: an updated meta-analysis and systematic review. | Sun A et al. | β | 2026 | β |
| Altered association between cortisol and adrenocorticotropic hormone levels in the early stage of type 2 diabetic ketoacidosis. | Wang L et al. | β | 2025 | β |
| Correlation between stress hyperglycemia ratio and risk of acute respiratory distress syndrome in patients with sepsis: a MIMIC-IV cohort study. | Jin X et al. | β | 2025 | β |
| Dual-Strain Psychobiotics Combining Live <i>Lactiplantibacillus plantarum</i> PS128 and Heat-Treated <i>Lacticaseibacillus paracasei</i> PS23 Improve Psychological and Neuroendocrine Outcomes in Stressed Adults: A Randomized, Placebo-Controlled Trial. | Lee MC et al. | β | 2025 | β |
| Severe reversible cardiomyopathy associated with adrenal crisis caused by isolated adrenocorticotropin deficiency: a case report. | Wang L et al. | β | 2025 | β |
| Changes in serum cortisol levels after 10 days of overfeeding and fasting. | Colling C et al. | β | 2023 | β |
| The Effect of Disease and Injury on Faecal Cortisol Metabolites, as an Indicator of Stress in Wild Hospitalised Koalas, Endangered Australian Marsupials. | Santamaria F et al. | β | 2023 | β |
| Sepsis-associated hypoglycemia on admission is associated with increased mortality in intensive care unit patients. | Mitsuyama Y et al. | β | 2022 | β |
| The Added Value of Serum Random Cortisol and Thyroid Function Tests as Mortality Predictors for Critically Ill Patients: A Prospective Cohort Study. | Muentabutr N et al. | β | 2022 | β |
| Adrenal Insufficiency Secondary to Septic Shock in a Male Patient with Iatrogenic Cushing's Syndrome: 2 sides of the Same Coin? | Foppiani L | β | 2021 | β |
| Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study. | GΓΌven M et al. | β | 2021 | β |
| Glucocorticoid exposure predicts survival in female baboons. | Campos FA et al. | β | 2021 | β |
| Integrated associations of nasopharyngeal and serum metabolome with bronchiolitis severity and asthma: A multicenter prospective cohort study. | Fujiogi M et al. | β | 2021 | β |
| Persisting neuroendocrine abnormalities and their association with physical impairment 5Β years after critical illness. | Vanhorebeek I et al. | β | 2021 | β |
| Hydrocortisone with fludrocortisone for septic shock: a systematic review and meta-analysis. | Yamamoto R et al. | β | 2020 | β |
| Impact of underlying chronic adrenal insufficiency on clinical course of hospitalized patients with adrenal crisis: A nationwide cohort study. | Iwasaku M et al. | β | 2019 | β |
| Investigating the Hypothesis of Stress System Dysregulation as a Risk Factor for Central Serous Chorioretinopathy: A Literature Mini-Review. | Scarinci F et al. | β | 2019 | β |
| Redefining the perioperative stress response: a narrative review. | Manou-Stathopoulou V et al. | β | 2019 | β |
| Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit. | Bekhit OE et al. | β | 2019 | β |
| An Approach to Minimising Risk of Adrenal Insufficiency When Discontinuing Oral Glucocorticoids. | Nicholas MN et al. | β | 2018 | β |
| Impairment of Thyroid Function in Critically Ill Patients in the Intensive Care Units. | Kumar E et al. | β | 2018 | β |
| Polygenic risk score of SERPINA6/SERPINA1 associates with diurnal and stress-induced HPA axis activity in children. | Utge S et al. | β | 2018 | β |
| Adrenal insufficiency in critical patients: New ethiopathogenic concepts and therapeutic implications. | Mateos Moreno L et al. | β | 2017 | β |
| Clinical characteristics of adrenal crisis in adult population with and without predisposing chronic adrenal insufficiency: a retrospective cohort study. | Iwasaku M et al. | β | 2017 | β |
| Controversies in Corticosteroid use for Sepsis. | Long B et al. | β | 2017 | β |
| Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus. | Williams KM et al. | β | 2017 | β |
| Near-fatal Anorexia Nervosa in a Middle-aged Woman. | Foppiani L et al. | β | 2017 | β |
| On the Neuroendocrinopathy of Critical Illness. Perspectives for Feeding and Novel Treatments. | Van den Berghe G | β | 2016 | β |
| Brain-lung crosstalk: Implications for neurocritical care patients. | Mrozek S et al. | β | 2015 | β |
| Diabetes alters the blood glucose response to ketamine in streptozotocin-diabetic rats. | Chen H et al. | β | 2015 | β |
| Inhibition of endogenous glucocorticoid synthesis aggravates lung injury triggered by septic shock in rats. | Incerpi EK et al. | β | 2015 | β |
| Relative Adrenal Insufficiency in Pediatric Septic Shock. | Vila-PΓ©rez D et al. | β | 2015 | β |
| CBS and CSE are critical for maintenance of mitochondrial function and glucocorticoid production in adrenal cortex. | Wang CN et al. | β | 2014 | β |
| Current Use of Steroids in Critical Care. | Dabo Trubelja A | β | 2014 | β |
| Glucocorticoids as an emerging pharmacologic agent for cardiopulmonary resuscitation. | Varvarousi G et al. | β | 2014 | β |
| Hypothalamic-pituitary-adrenal axis in lethal canine Staphylococcus aureus pneumonia. | CortΓ©s-Puch I et al. | β | 2014 | β |
| Induction of M2 regulatory macrophages through the Ξ²2-adrenergic receptor with protection during endotoxemia and acute lung injury. | Grailer JJ et al. | β | 2014 | β |
| Soluble urokinase plasminogen activator receptor, the candidate prophetic biomarker in severe inflammatory response syndrome. | Vasarhelyi B | β | 2014 | β |
| Glucocorticosteroid in treatment of severe pneumonia. | Ariani F et al. | β | 2013 | β |
| Hydrocortisone reduces the beneficial effects of toll-like receptor 2 deficiency on survival in a mouse model of polymicrobial sepsis. | Bergt S et al. | β | 2013 | β |
| Reduced cortisol metabolism during critical illness. | Boonen E et al. | β | 2013 | β |
| Reduced glucocorticoid receptor protein expression in children with critical illness. | Indyk JA et al. | β | 2013 | β |
| Regulation of IL-17 family members by adrenal hormones during experimental sepsis in mice. | Bosmann M et al. | β | 2013 | β |
| Stress-response pathways are altered in the hippocampus of chronic alcoholics. | McClintick JN et al. | β | 2013 | β |
| Presenting symptoms of myocardial infarction predict short- and long-term mortality: the MONICA/KORA Myocardial Infarction Registry. | Kirchberger I et al. | β | 2012 | β |
| Response to the high-dose corticotrophin stimulation test depends on plasma adrenocotropin hormone levels in septic shock. | Llompart-Pou JA et al. | β | 2012 | β |
| Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery. | Verweij EJ et al. | β | 2012 | β |
| Systemic steroids in severe sepsis and septic shock. | Patel GP et al. | β | 2012 | β |
| Assessment of the hypothalamic-pituitary-adrenal axis in critical illness. | Elbuken G et al. | β | 2011 | β |
| Corticosteroids for severe sepsis: an evidence-based guide for physicians. | Annane D | β | 2011 | β |
| Endotoxin tolerance of adrenal gland: attenuation of corticosterone production in response to lipopolysaccharide and adrenocorticotropic hormone. | Liu S et al. | β | 2011 | β |
| Evaluation of the anterior pituitary function in the acute phase after spontaneous subarachnoid hemorrhage. | Parenti G et al. | β | 2011 | β |
| Methylprednisolone exacerbates acute critical illness-related corticosteroid insufficiency associated with traumatic brain injury in rats. | Chen X et al. | β | 2011 | β |
| A possible role of neuropeptide Y in depression and stress. | Morales-Medina JC et al. | β | 2010 | β |
| A Single-Center Review of Prescribing Trends and Outcomes of Corticosteroid Replacement Therapy in Critically Ill Children with Septic Shock. | Benken ST et al. | β | 2010 | β |
| Depressive-like parameters in sepsis survivor rats. | Comim CM et al. | β | 2010 | β |
| Low dose dexamethasone reverses depressive-like parameters and memory impairment in rats submitted to sepsis. | Cassol OJ et al. | β | 2010 | β |
| Low serum cortisol predicts early death after acute myocardial infarction. | Reynolds RM et al. | β | 2010 | β |
| National UK audit of the short synacthen test. | Chatha KK et al. | β | 2010 | β |
| Sepsis-related stress response: known knowns, known unknowns, and unknown unknowns. | Peng J et al. | β | 2010 | β |
| Updating the evidence for the role of corticosteroids in severe sepsis and septic shock: a Bayesian meta-analytic perspective. | Moran JL et al. | β | 2010 | β |
| Waking up the gut in critically ill patients. | Meier JJ | β | 2010 | β |
| Novel pharmacologic approaches to the management of sepsis: targeting the host inflammatory response. | Wheeler DS et al. | β | 2009 | β |
| "Relative" adrenal insufficiency in critical illness. | Fleseriu M et al. | β | 2009 | β |