Sepsis and adrenal insufficiency Review
| Authors: | Fowler, C.; Raoof, N.; Pastores, S. M. |
| Review Title: | Sepsis and adrenal insufficiency |
| Abstract: | In sepsis, dysregulation of the hypothalamic–pituitary–adrenal axis, alterations in cortisol metabolism, and tissue resistance to glucocorticoids can all result in relative adrenal insufficiency or critical illness-related corticosteroid insufficiency (CIRCI). The symptoms and signs of CIRCI during sepsis are nonspecific, generally including decreased mental status, unexplained fever, or hypotension refractory to fluids, and the requirement of vasopressor therapy to maintain adequate blood pressure. While we have been aware of this syndrome for over a decade, it remains a poorly understood condition, challenging to diagnose, and associated with significantly diverging practices among clinicians, particularly regarding the optimal dosing and duration of corticosteroid therapy. The existing literature on corticosteroid use in patients with sepsis and septic shock is vast with dozens of randomized controlled trials conducted across the past 4 decades. These studies have universally demonstrated reduced duration of shock, though the effects of corticosteroids on mortality have been inconsistent, and their use has been associated with adverse effects including hyperglycemia, neuromuscular weakness, and an increased risk of infection. In this article, we aim to provide a thorough, evidence-based, and practical review of the current recommendations for the diagnosis and management of patients with sepsis who develop CIRCI, explore the controversies surrounding this topic, and highlight what lies on the horizon as new evidence continues to shape our practice. © The Author(s) 2023. |
| Keywords: | prednisone; review; gastrointestinal hemorrhage; outcome assessment; diagnostic accuracy; ipilimumab; quality of life; microrna; midazolam; propofol; delirium; inflammation; dexamethasone; proteomics; cancer therapy; risk factor; hypothalamus hypophysis system; fever; hyperglycemia; genome analysis; hyperkalemia; hyponatremia; hypotension; intensive care unit; length of stay; hospitalization; interleukin 6; muscle weakness; glucocorticoid; hypoglycemia; sepsis; chimeric antigen receptor; blood pressure; methylprednisolone; weakness; hydrocortisone; hypogonadism; corticosteroid; cytokine release; immunosuppressive treatment; sleep disorder; mental health; hemodynamics; hypernatremia; noradrenalin; artificial ventilation; etomidate; critical illness; adult respiratory distress syndrome; hemophagocytic syndrome; hypothalamus hypophysis adrenal system; allodynia; adrenal insufficiency; hospital mortality; randomized controlled trial (topic); complication; fludrocortisone; corticotropin; hypophysitis; corticosteroids; eosinophilia; septic shock; hypercortisolism; proopiomelanocortin; corticosteroid therapy; adrenal cortex hormones; cytokine release syndrome; hypophysis adrenal system; hypothalamo-hypophyseal system; pituitary-adrenal system; shock, septic; epinephrine; tocilizumab; procalcitonin; muscle mass; nivolumab; humans; human; argipressin |
| Journal Title: | Journal of Intensive Care Medicine |
| Volume: | 38 |
| Issue: | 11 |
| ISSN: | 0885-0666 |
| Publisher: | Sage Publications |
| Date Published: | 2023-11-01 |
| Start Page: | 987 |
| End Page: | 996 |
| Language: | English |
| DOI: | 10.1177/08850666231183396 |
| PUBMED: | 37365820 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Stephen Pastores -- Source: Scopus |
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