Tasty Morsels of Critical Care Tasty Morsels of Critical Care 025 | Andrenocortical insufficiency
5 snips
Feb 4, 2021 Dive into the world of adrenocortical insufficiency and discover its critical role in the ICU. Learn how cortisol functions and why standard serum levels can be misleading. Explore the different types of adrenal insufficiency, including Addison's, and what signs to look for during an adrenal crisis. Find out the best practices for immediate management, like the importance of hydrocortisone, and how long-term steroid use can lead to secondary adrenal insufficiency. Essential insights for anyone in critical care!
AI Snips
Chapters
Transcript
Episode notes
Cortisol’s Complex Physiology Matters
- Cortisol is the critical corticosteroid in ICU physiology with wide roles in vascular tone, immune function, and adrenergic receptor expression.
- Serum cortisol levels poorly predict cellular activity because of binding, pulsed secretion, and intracellular activation/inactivation.
Three Types With Different Causes
- Adrenocortical insufficiency splits into primary, secondary, and critical illness–related types that differ in mechanism and implications.
- Primary (Addison's) is now mainly autoimmune against 21-hydroxylase in Western countries, not TB.
Treat Suspected Adrenal Crisis Immediately
- In suspected adrenal crisis give 100 mg hydrocortisone immediately along with needed fluids rather than waiting for cortisol results.
- The UK Society for Endocrinology supports treating first and checking levels later, and some advocate a 24-hour infusion.