Pancreatic and Adrenal Disorders

Critically ill patients who lack preexisting endocrine diagnoses may still develop endocrine dysfunction, as exhibited by critical illness-related corticosteroid insufficiency and glycemic abnormalities. Glycemic control remains an important issue in critically ill patients, as hyperglycemia, hypoglycemia, and glucose variability are all independently associated with increased mortality. Hyperglycemia is a common manifestation of critical illness that may result from an acute response to stress and injury or may reflect preexisting diabetes mellitus. Hypoglycemia most commonly occurs as a result of treatment of hyperglycemia but may also be due to other causes such as sepsis and decreased nutritional intake. Hypoglycemia and other glycemic emergencies such as diabetic ketoacidosis and a hyperosmolar hyperglycemic state must be quickly recognized and treated. This review provides a general overview of diabetes mellitus, glycemic targets in the critically ill, glycemic emergencies, adrenal gland disorders, pheochromocytoma, and carcinoid syndrome. This review contains 1 figures, 4 tables, and 43 references. Keywords: adrenal crisis, carcinoid syndrome, critical illness-related corticosteroid insufficiency, Cushing syndrome, diabetes mellitus, diabetic ketoacidosis, glycemic goals, hyperosmolar hyperglycemic state, hypoglycemia, pheochromocytoma