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Review Article
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- Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines
- Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Bhupinder Singh, Rohit Jain
- Acute Crit Care. 2024;39(3):331-340. Published online August 30, 2024
- DOI: https://doi.org/10.4266/acc.2024.00647
- 51,591 View
- 2,762 Download
- 8 Web of Science
- 10 Crossref
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Abstract
PDF - Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.
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Citations
Citations to this article as recorded by
- Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
Xinlong Zhang, Kaizong Huang, Zixin Wu, Rui Ding, Junming Han, Yuan Zhang, Yaping Lu, Yingmei Lu, Yanna Si
Pharmacology & Therapeutics.2026; 278: 108971. CrossRef - Brain-Region-Mediated Neuroimmune Modulation in Sepsis: Research Advances and Therapeutic Prospects
Xuechun Zhou, Ying Tang, Hui Chen, Wei Huang, Haibo Qiu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef - Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients
Sophon Dumrongsukit, Suranut Charoensri, Kamonwan Mulalin, Anupol Panitchote
Journal of Intensive Care Medicine.2026;[Epub] CrossRef - Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand
Auttawut Chalermwutanon, Sawangjit Saejaow, Veerapong Vattanavanit
Acute and Critical Care.2026; 41(1): 107. CrossRef - Neuroendocrine Balance Index: an Indicator of Metabolic Response to Surgical Stress in Cardiac Surgery
Lada O. Sobanska, Volodymyr I. Cherniy
Ukrainian Journal of Cardiovascular Surgery.2026; 34(1): 119. CrossRef - Physiological Influence of Licorice Extract on Some Hormonal and Biochemical Parameters Alterations Induced by Glucocorticoid in Male Rats
Sohier Syame, Safinaz Badie
Ricos Biology.2025; 3(2): 19. CrossRef - Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
Ashley N. Radig, Vanessa A. Curtis, Erik Westlund, Christina L. Cifra
Journal of Intensive Care Medicine.2025; 40(12): 1285. CrossRef - Recognizing and managing critical illness-related corticosteroid insufficiency in pediatric critical care
Ja Hye Kim
Archives of Pediatric Critical Care.2025; 3(1): 14. CrossRef - A consensus blood transcriptomic framework for sepsis
Brendon P. Scicluna, Kiki Cano-Gamez, Katie L. Burnham, Emma E. Davenport, Andrew Reese Moore, Soumen Khan, Charles J. Hinds, Olaf L. Cremer, Purvesh Khatri, Timothy E. Sweeney, Julian C. Knight, Tom van der Poll
Nature Medicine.2025; 31(12): 4119. CrossRef - Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a Middle Eastern Cohort
Fayez Alshamsi, Saeed Alkaabi, Maryam Nasser Mohamedali Alfadli, Naser Abdulla Naser Salem Alshkeili, Sultan Majed Ibrahim Alhosani, Adnan Agha
Diagnostics.2025; 15(20): 2588. CrossRef
- Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
Case Report
- Cardiology/Endocrinology
- Acute Adrenal Insufficiency Associated with Acute Coronary Syndrome
- Youngji Kim, Woojin Jung, Inkuk Cho, Seyeol Yang, Ho Han, Jung Hwan Park
- Korean J Crit Care Med. 2014;29(3):226-230. Published online August 31, 2014
- DOI: https://doi.org/10.4266/kjccm.2014.29.3.226
- 10,348 View
- 102 Download
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Abstract
PDF
- Acute adrenal insufficiency (AAI) in acute coronary syndrome (ACS) patients is rare and may be frequently underestimated as simple ACS, since symptoms of AAI are nonspecific. Physicians should be fully aware of the possibility of occult AAI combined with ACS, if clinical suspicion is high. Herein, we report a rare case of a 67-year-old female patient with concomitant AAI and drug eluting stent fracture-induced ACS. To our knowledge, there have been no case reports of AAI associated with ACS in Korea.
Review Article
- Hormonal Changes in Critical Condition
- Heung Bum Lee, Chi Ryang Chung
- Korean J Crit Care Med. 2010;25(3):123-129.
- DOI: https://doi.org/10.4266/kjccm.2010.25.3.123
- 4,056 View
- 46 Download
- 1 Crossref
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Abstract
PDF
- When disease or trauma progresses to a critical state, the reaction of the endocrine system in creating homeostasis is essential for survival. The association between the severity of hormonal changes and outcome in terms of morbidity and mortality has led to the challenge of development of several endocrine treatments. During sepsis, nitric oxide-mediated apoptosis is observed in the neurons and glial cells of the cerebrovascular centers of the autonomic nervous system. It is probably one of the components of the circulatory dysfunction of sepsis. The regulation of different organs was neither linear nor independent however organs were found to behave as biological oscillators coupled to each other through neurological or hormonal communication pathways. Sepsis, because of systemic inflammatory responsive syndrome, disrupts these communication pathways and leads to organ failures. Endocrine hormonal issues related to the intensive care setting are common challenges to ICU specialists. Disruptions of the endocrine system in sepsis are characterized by 1) an increase in cortisol plasma levels with a loss of the circadian rhythm of its secretion; 2) hyperglycemia due to insulin resistance and rise in hyperglycemic hormones secretion; 3) relative vasopressin deficiency; and 4) euthyroid sick syndrome or non-thyroidal illness syndrome. This article discusses the dynamic changes of four main endocrine axes: hypothalamic-pituitary-adrenal axis, insulin, vasopressin and thyroid during grave states of disease, when a patient is in critical condition.
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Citations
Citations to this article as recorded by- The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon
Korean Journal of Critical Care Medicine.2012; 27(4): 255. CrossRef
- The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
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