Diagnosis of adrenal failure in critically ill patients
Open accessAbstract
In 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 μg) or high doses (250 μg); 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.
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In the intensive care setting, a random cortisol level >25 μg/dL during the stressed state suggests adrenal sufficiency.
“In the intensive care setting, a random cortisol level >25 µg/dL during the stressed state suggests adrenal sufficiency [28].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [28]
The ‘Baseline total cortisol and free cortisol’ section reports that some trials found levels above 25 μg/dL usual in stressed patients without adrenal dysfunction, supporting the claim as a suggested cutoff. But the same section says there is no consensus on the cutoff, and the ‘Consensus’ section proposes excluding adrenal dysfunction only above 34–44 μg/dL. Page numbers were not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOther pediatric TBI studies found an incidence of TSH deficiency at one year after injury (5%-12%) similar to adult TBI studies (2%-22%).
“Other pediatric TBI studies found an incidence of TSH deficiency at one year after injury (5%–12%) similar to that observed in adult TBI studies (2%–22%) [21,28,29,30].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [28]
The High dose cortrosyn test and Low dose cortrosyn test sections discuss cortisol responses and adrenal dysfunction in critically ill patients, not TSH deficiency after traumatic brain injury. Searches for pediatric TBI, TSH deficiency, and the stated pediatric and adult incidence ranges found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDiabetes insipidus can be evident within hours to days after TBI, but onset may be delayed as long as 30 days after injury.
“DI can be evident within hours to days after the injury, but, alternatively, the onset of DI may be delayed as long as 30 days after injury [28].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [28]
The Abstract describes a review of adrenal insufficiency in critically ill patients, and the Physiopathology section discusses cortisol and pituitary-hormone responses, not diabetes insipidus after traumatic brain injury. Searches for diabetes insipidus, TBI, and onset up to 30 days after injury found no passage addressing the claimed timeline. Page numbers were not available in our copy. (LLM, conf=0.78)
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Endocrinopathy and Dysautonomia
Fote, G., Himstead, A. S., & Chen, J. W. (2025) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2025.03.008
- Authors
- Moraes, R. B., Czepielewski, M. A., Friedman, G., & Borba, E. L. D.
- Affiliations
- Hospital de Clínicas de Porto Alegre (BR)
- Universidade Federal do Rio Grande do Sul (BR)
- Venue
- Arquivos Brasileiros de Endocrinologia & Metabologia
- Publisher
- FapUNIFESP (SciELO)
- Published
- 2011-06
- Volume
- 55
- Issue
- 5
- Pages
- 295-302
- ISSN
- 0004-2730 (ISSN-L)
- OpenAlex
- W2040048301
- Cited by
- 20
- References
- 38
- Citations by year
- 2025: 1 · 2024: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- Arquivos Brasileiros de Endocrinologia & Metabologia (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, cc-by-nc-sa)
- Lume (Universidade Federal do Rio Grande do Sul) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Keywords
- critical illness-related corticosteroid insufficiency, relative adrenal insufficiency, adrenal insufficiency diagnosis, hypothalamic-pituitary-adrenal axis, metyrapone test, salivary cortisol, free cortisol, septic shock, corticosteroid therapy, critically ill patients
- MeSH terms
- Adrenal Insufficiency, Adrenocorticotropic Hormone, Arginine Vasopressin, Corticotropin-Releasing Hormone, Cosyntropin, Critical Care, Humans, Hydrocortisone, Metyrapone, Pituitary Gland, Steroids, Critical Illness
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