Diagnosis and Treatment of Adrenal Insufficiency in the Critically Ill Patient

Kwame Asare, Pharm.D.

Disclosures

Pharmacotherapy. 2007;27(11):1512-1528. 

In This Article

Conclusion

Adrenal insufficiency can be life threatening in stressful situations, and its diagnosis is always a challenge, especially in patients with critical illness. Since the condition appears to be common in patients with septic shock, clinicians should have a high index of suspicion for its occurrence in critically ill patients with persistent hypotension despite adequate fluid resuscitation and/or poor hemodynamic response to vasopressors. Careful history taking and physical examination, complemented by other signs such as hyponatremia and hyperkalemia, should help identify most cases. Treatment with physiologic doses of corticosteroids should be started as soon as possible since short-term treatment carries very few risks and has been shown to decrease both morbidity and mortality.

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