Reduced cortisol metabolism during criticall illness. NEJM, March 2013 [online]
Boonen, E., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1214969?af=R&rss=currentIssue#t=articleTop
Critical illness, an example of severe acute physical stress, is often accompanied by hypercortisolemia that is proportionate to the severity of illness.1,2 This observation has traditionally been attributed to stress-induced activation of the hypothalamic–pituitary–adrenal (HPA) axis and increased corticotropin-driven cortisol production.3 However, this stress response may not be sufficient for a good prognosis in patients with relative adrenal insufficiency.
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