Key messages

• Glucocorticoids act on numerous tissues via the intracellular cytosol-nuclear receptor mechanism.

• Glucocorticoids are important for cardiovascular function with permissive effects on the vasopressor actions of norepinephrine (noradrenaline) and angiotensin II.

• Failure to produce aldosterone results in renal sodium wasting with concomitant water loss and potassium retention.

• In acute hypoadrenalism (adrenal crisis), hemodynamic instability and shock, which is often unresponsive to volume loading and vasopressor agents, are prominent features.

• The concept of relative adrenal insufficiency in critically ill patients, representing an inadequate adrenal response to severe stress, has emerged. Introduction

Hypoadrenalism is an uncommon condition in the intensive care unit (ICU), but it has important consequences and is potentially life-threatening when not recognized in time. Hypoadrenalism is either primary, as the result of adrenal pathology, or secondary as a consequence of hypothalamic-pituitary insufficiency (deficient secretion of pituitary ACTH or hypothalamic corticotrophin-releasing hormone (CRH)). Iatrogenic hypoadrenalism caused by suppression of the hypothalamic-pituitary-adrenal axis by glucocorticoid administration is a relatively common condition.

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