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Previous Volume 337:1285-1292 October 30, 1997 Number 18 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Severe illnesses, trauma, anesthesia, and surgery are accompanied by activation of the hypothalamic–pituitary–adrenal axis, as demonstrated by increased serum corticotropin and cortisol concentrations.^{1,2,3,4,5,6,7} This activation is an essential component of the general adaptation to stress and contributes to the maintenance of homeostasis.⁸ The efficacy of replacement doses or high doses of corticosteroids in patients with severe illness, especially those with multiorgan-system diseases, is uncertain.^9,10,11,12 The uncertainty is even greater in patients who are already taking corticosteroids. Standard therapy for the latter patients consists of the administration of high doses of corticosteroids during any severe illness and perioperatively. We review here . . . [Full Text of this Article]

Effect of Corticosteroids on Circulatory Aspects of the Stress Response

The Normal Response of the Hypothalamic–Pituitary–Adrenal Axis to Critical Illness and the Concept of Relative Adrenal Insufficiency

Corticosteroid Therapy for Critical Illness

Corticosteroid Therapy in Patients with Known Adrenal Dysfunction

Patients with Chronic Autoimmune or Inflammatory Diseases Treated with Corticosteroids

Patients with Previously Diagnosed Hypothalamic–Pituitary–Adrenal Insufficiency

Conclusions

Source Information

From the Departments of Medicine (S.W.J.L., F.H.J.) and Surgery (H.A.B.), Erasmus University, Rotterdam, the Netherlands.

Address reprint requests to Dr. Lamberts at the Department of Medicine, University Hospital Dijkzigt, 40 Dr. Molewaterplein, 3015 GD Rotterdam, the Netherlands.

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