Search
Adrenal Insufficiency in the Critically Ill
- Adrenal insufficiency (AI) is estimated to occur in up to 30% of critically ill patients
- The most common causes of AI in the critically ill are SIRS and sepsis
- In most cases of critically ill patients, AI is functional (i.e relative) - the adrenal response is insufficient to respond to the degree of stress
- Diagnostic clues include hyponatremia, hyperkalemia, hypoglycemia (rare), and hemodynamic instability despite IVFs and vasopressors
- Although still controversial, most feel that AI is present in critically ill patients with either a basal cortisol < 15 mcg/dl, an increase in < 9 mcg/dl after ACTH stimulation, or a random cortisol < 25 mcg/dl
- IV hydrocortisone, methylprednisolone, and dexamethasone are the 3 glucocorticoids most commonly administered
- Hydrocortisone is usually the preferred agent because it is the synthetic equivalent of cortisol (and has both glucocorticoid and mineralocorticoid activity)