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Endocrine Abstracts (2016) 44 CMW3.6 | DOI: 10.1530/endoabs.44.CMW3.6

SFEBES2016 Clinical Management Workshops Workshop 3: How do I… (6 abstracts)

How do I determine Cortisol deficiency in the critically ill patient?

Jeremy Tomlinson


University of Oxford, Oxford, UK.


Critical illness is associated with significant morbidity and mortality. The changes in the hypothalamo-pituitary-adrenal (HPA) axis that occur during critical illness are complex and whilst early studies had suggested improved outcome in patients with septic shock treated with parenteral glucocorticoids, this was not endorsed in subsequent studies and it remains a highly controversial area.

In patients with underlying pituitary or adrenal disease where compromise of HPA axis function is documented prior to the onset of critical illness, stress dose hydrocortisone replacement is essential, although there is still debate as to the precise dose and mode of administration.

In the absence of established endocrine disease, diagnosing adrenal insufficiency during critical illness (often termed relative adrenal insufficiency or critical illness related corticosteroid insufficiency) remains contentious and challenging. There are few robust data upon which to base absolute cut-offs and differences between cortisol assays add a further layer of complexity. Studies using both 250 μg and 1 μg short Synacthen tests have been used and incremental cut-offs have been proposed and these will be discussed. However, the most recent guidance available for the management of septic shock advises against the use of dynamic testing of the HPA axis. Furthermore, recent insights into the dynamics of cortisol metabolism have suggested that many of the abnormalities that are observed during critical illness may relate to decreased cortisol clearance. This has implications both for the interpretation of the assessments that are made as well as the doses of hydrocortisone treatment that may be used.

Volume 44

Society for Endocrinology BES 2016

Brighton, UK
07 Nov 2016 - 09 Nov 2016

Society for Endocrinology 

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