Adrenal dysfunction in critically ill patients

Adrenal dysfunction in critically ill patients. NEJM, March 2013 [online]

Gomez-Sanchez, C.E.

http://www.nejm.org/doi/full/10.1056/NEJMoa1214530?af=R&rss=currentIssue

Critical illness elicits a major stress response that activates the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, the administration of corticotropin stimulates cortisol secretion and causes structural changes in the adrenal gland that include adrenal-cell hypertrophy and hyperplasia. Adrenal glands that are obtained on autopsy from patients who have died after a prolonged critical illness are relatively heavy, and progressively compact lipid-depleted cells replace lipid-laden fasciculata cells.