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Báo cáo khoa học: "The diagnosis of adrenal insufficiency in the critically ill patient: does it really matter"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The diagnosis of adrenal insufficiency in the critically ill patient: does it really matter? | Available online http ccforum.eom content 10 6 175 Commentary The diagnosis of adrenal insufficiency in the critically ill patient does it really matter Paul E Marik Division of Pulmonary and Critical Care Medicine Thomas Jefferson University Walnut Street Philadelphia Pennsylvania 19107 USA Corresponding author Paul Marik paul.marik@jefferson.edu Published 29 November 2006 This article is online at http ccforum.com content 10 6 175 2006 BioMed Central Ltd Critical Care 2006 10 175 doi 10.1186 cc5105 See related research by Salgado et al. http ccforum.com content 10 5 R149 Abstract The definition of what constitutes a normal adrenal response to critical illness is unclear. Consequently published studies have used a variety of biochemical criteria to define adrenal insufficiency . These criteria have been based on the baseline cortisol level or the increment in cortisol following corticotropin administration. However in critically ill patients there are a number of confounding factors that make interpretation of these tests difficult. Furthermore in those patients who are most likely to benefit from treatment with low-dose glucocorticoids there is no evidence that treatment should be based on adrenal function testing. In those patients in whom the diagnosis of adrenal insufficiency may be important this diagnosis may best be made based on the free cortisol level or the total cortisol level stratified by serum albumin. The definition of what constitutes a normal adrenal response to critical illness is unclear 1 . Consequently published studies have used a variety of biochemical criteria to define abnormalities in adrenal function during critical illness. These criteria have been based on the stress baseline cortisol level or the increment in cortisol delta cortisol following administration of 250 Lg corticotropin. However in critically ill patients there are a number of confounding factors that make interpretation of these tests difficult. Most importantly the .