Acute adrenal insufficiency, a rare cause of shock, is manifestedas shock that is poorly responsive to fluid resuscitation andpressors, not unlike cardiogenic or septic shock. It is almostalways associated with a history of supraphysiologic glucocorticoidadministration or primary adrenal cortical disease. The bestsingle test for the evaluation and diagnosis of this disorderis based on the ability of the adrenal glands to respond toa challenge with synthetic adrenocorticotropic hormone (250µg of cosyntropin administered as an intravenous bolus,followed by the measurement of plasma cortisol levels 30 and60 minutes later). Normally, the plasma cortisol . . . [Full Text of this Article]
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From the Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Sciences University, Portland.
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Free Cortisol and Critically Ill Patients
Khan T., Kupfer Y., Tessler S., Polderman K. H., van Zanten A., Girbes A. R.J., Jackson W. L. Jr., Shorr A. F., Vogeser M., Briegel J., Arafah B. M., Loriaux L.
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N Engl J Med 2004;
351:395-397, Jul 22, 2004.
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Khan, T., Kupfer, Y., Tessler, S., Polderman, K. H., van Zanten, A., Girbes, A. R.J., Jackson, W. L. Jr., Shorr, A. F., Vogeser, M., Briegel, J., Arafah, B. M., Loriaux, L.
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