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Adrenal insufficiency in critical illness NEJM V348;8 p727-734 By Evan Chang, MD.

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Presentation on theme: "Adrenal insufficiency in critical illness NEJM V348;8 p727-734 By Evan Chang, MD."— Presentation transcript:

1 Adrenal insufficiency in critical illness NEJM V348;8 p727-734 By Evan Chang, MD

2 Raff, H. et. al. Ann Intern Med 2003;138:980-991 The hypothalamic-pituitary-adrenal control system

3 Raff, H. et. al. Ann Intern Med 2003;138:980-991 The cortisol-cortisone shuttle

4 Lamberts, S. W.J. et al. N Engl J Med 1997;337:1285-1292 Serum Cortisol Concentrations during Surgery and Acute Illness

5 Lamberts, S. W.J. et al. N Engl J Med 1997;337:1285-1292

6 Cooper, M. S. et al. N Engl J Med 2003;348:727-734 Features Suggesting Corticosteroid Insufficiency

7 Cooper, M. S. et al. N Engl J Med 2003;348:727-734 Investigation of Adrenal Corticosteroid Function in Critically Ill Patients on the Basis of Cortisol Levels and Response to the Corticotropin Stimulation Test

8 Cooper, M. S. et al. N Engl J Med 2003;348:727-734 Suggested Corticosteroid-Replacement Doses during Intercurrent and Acute Illness in Patients with Proven or Suspected Adrenal Insufficiency, Including Those Receiving Corticosteroid Therapy


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