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Diagnosis of adrenal failure in critically ill patients Moraes RB; Czepielewski MA; Friedman G; Borba ELArq Bras Endocrinol Metabol 2011[Jun]; 55 (5): 295-302In the last two decades there was important evolution on the knowledge of the function of the hypothalamic-pituitary-adrenal axis. In the last decade, the expression "relative adrenal insufficiency" (RAI) was created, and more recently "critical illness-related corticosteroid insufficiency" (CIRCI) was used to designate those patients in which cortisol production was not sufficiently increased in stress situations. Patients with CIRCI have elevated hospital morbidity and mortality. Currently, there is a wide discussion about diagnostic criteria for this dysfunction. Besides basal cortisol, some publications now study the role of other tests, such as cortrosyn test - either in low (1 mug) or high doses (250 mug); free cortisol, salivary cortisol, metyrapone test and others. With this review, we aimed at summarizing the results of the most influent papers that intended to define diagnostic criteria for CIRCI. We also suggest an approach for CIRCI diagnosis and make it clear that the decision about steroid therapy in septic shock patients is matter apart from RAI.|*Critical Care[MESH]|Adrenal Insufficiency/*diagnosis/drug therapy[MESH]|Adrenocorticotropic Hormone/metabolism[MESH]|Arginine Vasopressin/metabolism[MESH]|Corticotropin-Releasing Hormone/metabolism[MESH]|Cosyntropin[MESH]|Critical Illness[MESH]|Humans[MESH]|Hydrocortisone/analysis/deficiency[MESH]|Metyrapone[MESH]|Pituitary Gland/physiopathology[MESH]|Steroids/administration & dosage/physiology[MESH] |
