Activation of Hypothalamic Pituitary Axis in Critically Ill Patients

Abstract

In the absence of definite data in the literature regarding the value of serum cortisol concentrations in patients with different types of critical illness, we reviewed the literature to propose guidelines that would be useful for physicians. We also discuss methods of assessing hypothalamic pituitary axis function during critical illness. We found that serum random cortisol is higher than 15 μg/dL in critically ill patients, with normal levels of binding proteins. In such patients, the adrenocorticotropic hormone-stimulated values are generally over 30 μg/dL with lower levels expected in critically ill patients, with hypoproteinemia. We conclude that physicians should use their own clinical judgment in deciding whether to use exogenous glucocorticoids or not, without depending on the levels of serum cortisol, and we recommend continuous intravenous infusion or frequent intravenous boluses (every 4–6 hours) for patients requiring steroids for nonadrenal related causes.