Q: The reason behind adrenal insufficiency in critical illness is? (select one)
A) Subnormal corticosteroid production
B) Increased cellular steroid utilization
During critical illnesses such as septic shock, the reason behind adrenal insufficiency is subnormal corticosteroid production. The hypothalamic-pituitary-adrenal axis stays intact. This is referred to as functional or relative adrenal insufficiency. Another designated term is "critical illness-related corticosteroid insufficiency (CIRCI)." The administration of steroids during pressor-resistant shock despite adequate fluid resuscitation is to balance the altered hypothalamic-pituitary-adrenal (HPA) axis.
Despite the intact structure of the HPA axis, there are various reasons which lead to adrenal insufficiency. This includes HPA activation which actually increases the circulating cortisol, HPA impairment which causes adrenocortical hyporesponsiveness, and glucocorticoid resistance.
Unfortunately, clinicians so far failed to reach any consensus definition of CIRCI, and management mostly depends on clinician's judgment and few guidelines.
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4. Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med 2017; 43:1751.