TY - CHAP M1 - Book, Section TI - Critical Illness–Related Corticosteroid Insufficiency A1 - Marik, Paul E. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Acute adrenal insufficiency in critically ill patients is best referred to as critical illness–related corticosteroid insufficiency (CIRCI).CIRCI may arise due to adrenal insufficiency or tissue resistance to cortisol.Adrenal insufficiency is best diagnosed by a random cortisol <10µg/dL (Type 1 CIRCI) or a delta of <9µg/dL after a 250µg cosyntropin stimulation test (Type II CIRCI).The diagnosis of adrenal insufficiency/CIRCI should not be made on the basis of laboratory criteria alone.Treatment with low-dose hydrocortisone (200 mg/day) or methylprednisolone (60 mg/day) should be considered in patients with septic shock who have responded “poorly” to resuscitation with fluids and vasopressor agents and those with ARDS who have failed to show an improvement within 48 hours of supportive care. The role of low-dose hydrocortisone in patients with severe sepsis and other clinical situations in the ICU remains to be determined. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107711431 ER -