RT Book, Section
A1 Marik, Paul E.
A1 Zaloga, Gary P.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2295669
T1 Chapter 79. Adrenocortical Insufficiency
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accesssurgery.mhmedical.com/content.aspx?aid=2295669
RD 2021/03/05
AB Activation  of  the  hypothalamic-pituitary-adrenal  (HPA)  axis  with  increased  glucocorticoid  activity  is  an  essential  component  of  the  general  adaptation  to  stress.Mediators  released  in  patients  with  sepsis  may  either  stimulate  or  impair  the  synthesis  and  action  of  cortisol  via  actions  on  the  HPA  axis  and  glucocorticoid  receptor.A  random  cortisol  level  in  a  highly  stressed  ICU  patient  is  currently  the  most  useful  test  to  assess  the  integrity  of  the  HPA  axis.A  stress  cortisol  level  of  less  than  25  μg/dL  in  a  highly  stressed  patient  (hypotensive,  respiratory  failure)  is  highly  suggestive  of  adrenal  failure.The  incidence  of  adrenal  failure  may  be  as  high  as  60%  in  patients  with  septic  shock.All  patients  with  suspected  HPA  axis  dysfunction  should  be  treated  with  stress  doses  of  hydrocortisone  (100  mg  q  8  IV)  pending  the  results  of  diagnostic  testing.A  random  cortisol  level  of  less  than  15  μg/dL  or  a  level  of  less  than  20  μg/dL  post  low-dose  corticotrophin  stimulation  testing  (low-dose  ACTH  test)  in  a  non-hypotensive  patient  with  unexplained  fever,  eosinophilia  or  altered  mental  status  warrants  a  trial  of  treatment  with  stress  doses  of  hydrocortisone.