Adrenal insufficiency in critical patients: New ethiopathogenic concepts and therapeutic implications.

• 发表时间: 12 2017
• 来源期刊: Endocrinol Diabetes Nutr
• DOI: 10.1016/j.endinu.2017.09.004
• PMID: 29137961
• 文章类型: Journal Article
• 作者列表: Mateos Moreno L,Palacios García N,Estrada García FJ

关键词: Adrenal insufficiency; Cortisol metabolism; Critical patient; Enfermo crítico; Insuficiencia suprarrenal; Metabolismo del cortisol

Mesh: Acute Disease; Adrenal Cortex Hormones / therapeutic use; Adrenal Insufficiency / diagnosis etiology physiopathology therapy; Chronic Disease; Critical Illness; Disease Progression; Hemodynamics; Humans; Hydrocortisone / metabolism; Hypothalamo-Hypophyseal System / physiopathology; Inflammation / etiology physiopathology; Models, Biological; Pituitary-Adrenal System / physiopathology; Stress, Physiological

Abstract

Recently, there have been advances in understanding of the changes that occur in the hypothalamic-pituitary-adrenal axis during the different stages of critical disease. Such advances have led to a paradigm change, so that the aforementioned adaptations are no longer considered the result of adrenal axis activation, but a consequence of decreased cortisol metabolism illness. Knowledge of this new pathophysiological bases should lead to reconsider the diagnosis and treatment of adrenal insufficiency in critically ill patients, a condition poorly understood to date.