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Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit

Mat Nor, Mohd Basri (2014) Diagnosing and treatment of adrenocortical insufficiency in the intensive care unit. Malaysian Society of Anaesthesiologists Yearbook 2013/2014, 2013/2014. pp. 60-67.

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In critically ill patients, activation of the hypothalamus-pituitary-adrenal (HPA) axis with the production of cortisol is crucial for survival under conditions of physiologic stress. The increase in cortisol production results in several important effects on metabolic, cardiovascular and immune aimed at restoring homeostasis during stress. However, in critical illness, HPA axis undergoes complex changes and the optimum level of plasma cortisol is unclear. In addition to activation of the HPA axis, cortisol metabolism and function may be significantly altered by various aspects of critical illness. There are conditions in which cortisol concentration cannot increase appropriately to meet demand. Assessment of cortisol activity in this group of patients is also difficult because laboratory assays of total plasma cortisol concentration and response to adrenocorticotropic hormone (ACTH) stimulation do not consistently reflect corticosteroid deficient at cellular level. It has been suggested that during critical illness, plasma cortisol concentration poorly reflect the glucocorticoid activity at target tissues. Venkatesh et al. has postulated that the spectrum of adrenocortical dysfunction in sepsis (from plasma to tissue) should be grouped under ‘sick euadrenal syndrome’ rather than an adrenocortical insufficiency.

Item Type: Article (Journal)
Additional Information: 5608/61858
Uncontrolled Keywords: Adrenocortical insufficiency (AI), intensive care unit (ICU), diagnose, treatment
Subjects: R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User: Dr. Mohd Basri Mat Nor
Date Deposited: 27 Feb 2018 10:05
Last Modified: 27 Feb 2018 10:05
URI: http://irep.iium.edu.my/id/eprint/61858

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