Adrenal glands/corticosteroids and multiple organ dysfunction syndrome

Abstract

The hypothalamic–pituitary–adrenal axis is part of a complex system that includes the autonomic nervous system, the vasopressinergic system and the γ-aminobutyric acid (GABA)ergic system. The integration of these systems along with the immune system is the key to the maintenance of life and homeostasis under conditions of daily stress. Dissonance of these system following an exogenous attack, such as infection, trauma, surgery, burns or drug abuse, or an endogenous danger, such as acute myocardial infarction, stroke or pancreatitis, results in critical illness. Adrenal insufficiency is one clinical manifestation of such a disruption in the homeostatic response to stress that may contribute to the development of organ failure and eventually death. In the intensive care unit, persisting hypotension or organ failure should prompt the performance of a corticotrophin test. If basal cortisol is<10µg/dl or the increase in cortisol is<9µg/dl then physicians should consider the presence of adrenal insufficiency. W...