A comparison of the adrenocortical response during septic shock and after complete recovery

Briegel, Josef; Schelling, Gustav; Haller, M.; Mraz, W.; Forst, H.; Peter, K.

doi:10.1007/bf02044113

Cited by 143 publications

(45 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This prevalence of relative adrenal insufficiency is among the highest previously reported in septic shock. [11][12][13][14][15][16][17][18] Our data also confirm that in the setting of a septic shock, diagnosing adrenal insufficiency based on clinical data is very difficult. Only the presence of severe hepatic failure (Child-Pugh grade C) was an indicator of adrenal dysfunction in our patients.…”

Section: Discussionsupporting

confidence: 72%

“…[11][12][13][14][15][16][17][18] Although plasma cortisol levels in these patients are normal or increased, they are inappropriately low to control the inflammatory response. Diagnosis of relative adrenal insufficiency is not possible on clinical grounds.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17][18] It also has been reported that patients with septic shock and relative adrenal insufficiency show resistance to vasoconstrictor drugs, 19 a higher incidence of refractory shock, 13 and very high hospital mortality rate. 11,15,17,18 Finally, various trials 12,20,21 and two meta-analyses 10,22 show that the administration of low doses of hydrocortisone (stress doses) during several days improves shock reversal and survival in septic shock.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

et al. 2006

View full text Add to dashboard Cite

Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality. This study prospectively evaluated the effects of steroids on shock resolution and hospital survival in a series of 25 consecutive patients with cirrhosis and septic shock (group 1). Adrenal function was evaluated by the short corticotropin test within the first 24 hours of admission. Patients with adrenal insufficiency were treated with stress doses of intravenous hydrocortisone (50 mg/6 h). Data were compared to those obtained from the last 50 consecutive patients with cirrhosis and septic shock admitted to the same intensive care unit in whom adrenal function was not investigated and who did not receive treatment with steroids (group 2). Incidence of adrenal insufficiency in group 1 was 68% (17 patients). Adrenal dysfunction was frequent in patients with advanced cirrhosis (Child C: 76% vs. Child B: 25%, P ‫؍‬ .08). Resolution of septic shock (96% vs. 58%, P ‫؍‬ .001), survival in the intensive care unit (68% vs. 38%, P ‫؍‬ .03), and hospital survival (64% vs. 32%, P ‫؍‬ .003) were significantly higher in group 1. The main causes of death in group 1 were hepatorenal syndrome or liver failure (7 of 9 patients). In contrast, refractory shock caused most of the deaths in group 2 (20 of 34 patients). In conclusion, relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock. Hydrocortisone administration in these patients is associated with a high frequency of shock resolution and high survival rate. (HEPATOLOGY 2006;44:1288-1295 B acterial infections are a frequent complication and an important cause of death in patients with advanced cirrhosis. 1-3 The mortality rate for patients admitted to the hospital with severe bacterial infections but without septic shock is approximately 30%, 4-6 although it may decrease to 10% if circulatory support with intravenous albumin is given at infection diagnosis. 7 The development of a complex syndrome characterized by acute deterioration of circulatory, hepatic, and renal function and hepatic encephalopathy is the main cause of death in these patients. 6,7 Prognosis of patients with cirrhosis admitted with septic shock is even worse. Hospital mortality in these patients ranges between 60% and 100%, 8,9 which is higher than that reported in the general population of patients with septic shock (25%-70%). [10][11][12] In our experience, survival of patients with cirrhosis in septic shock has not improved greatly during the past decades despite important advances in antibiotic treatment and general supportive measures.During the last few years, several studies have shown that septic shock is frequently associated with relative adrenal insufficiency, a condition characterized by an inadequate production of cortisol with respect to the peripheral demands. [11][12][13][14][15][16][17][18] It also has been reported that patients with septic shock and relative adrenal insufficiency sho...

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Este término se ha utilizado con frecuencia, los últimos años, en Medicina Intensiva para referirse a la necesidad de suplementación de cortisol y los beneficios que significan 37 . En los pacientes críticos, la falta de reconocimiento de esta entidad, o su reconocimiento tardío, se asocia a mayor incidencia de shock resistente a terapia con fluidos y vasopresores y mayor mortalidad [38][39][40][41] . El diagnóstico de este trastorno suprarrenal funcional no es posible a partir de parámetros clínicos 42 y actualmente se basa en la determinación sérica del cortisol total.…”

Section: Insuficiencia Suprarrenal Relativaunclassified

Para entender la acción de cortisol en inflamación aguda: una mirada desde la glándula suprarrenal hasta la célula blanco

Guerrero

2017

Rev. méd. Chile

View full text Add to dashboard Cite

“…Therefore, perhaps the use of repetitive measurements of plasma cortisol over time together with repetitive ACTH stimulation tests could shed more light on the nature of adrenocortical dysfunction in critically ill patients. It has already been suggested that the cortisol responsiveness to ACTH restores after recovery of illness, while a decreasing cortisol response during repetitive ACTH-testing was associated with a poor prognosis (23,49,50). Unfortunately, large enough and well-designed prospective clinical studies of systematic ACTH stimulation tests The use of repetitive cortisol measurements may be additionally important, taking into account the limitations of a single total or free cortisol measurement.…”

Section: E Boonen and G Van Den Berghementioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: New concepts to further unravel adrenal insufficiency during critical illness

Boonen

Berghe

2016

European Journal of Endocrinology

View full text Add to dashboard Cite

The concept of 'relative' adrenal insufficiency during critical illness remains a highly debated disease entity. Several studies have addressed how to diagnose or treat this condition but have often yielded conflicting results, which further fuelled the controversy. The main reason for the controversy is the fact that the pathophysiology is not completely understood. Recently, new insights in the pathophysiology of the hypothalamic-pituitary-adrenal axis response to critical illness were generated. It was revealed that high circulating levels of cortisol during critical illness are explained more by reduced cortisol breakdown than by elevated cortisol production. Cortisol production rate during critical illness is less than doubled during the day but lower than in healthy subjects during the night. High plasma cortisol concentrations due to reduced breakdown in turn reduce plasma ACTH concentrations via feedback inhibition, which with time may lead to an understimulation and hereby a dysfunction of the adrenal cortex. This could explain the high incidence of adrenal insufficiency in the prolonged phase of critical illness. These novel insights have created a new framework for the diagnosis and treatment of adrenal failure during critical illness that has redirected future research.

show abstract

A comparison of the adrenocortical response during septic shock and after complete recovery

Cited by 143 publications

References 23 publications

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

Para entender la acción de cortisol en inflamación aguda: una mirada desde la glándula suprarrenal hasta la célula blanco

MECHANISMS IN ENDOCRINOLOGY: New concepts to further unravel adrenal insufficiency during critical illness

Contact Info

Product

Resources

About