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Activation of Hypothalamic Pituitary Axis in Critically Ill Patients

Baba, Khaled El MD*; Zantout, Mira S. BS†; Azar, Sami T. MD‡

doi: 10.1097/TEN.0b013e318198b413
CME Review Article #4
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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.

*Endocrinology Fellow, †Research Assistant, and ‡Professor of Medicine, Department of Internal Medicine, Division of Endocrinology, American University of Beirut-Medical Center, New York.

The authors have disclosed that they have no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity.

All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute has identified and resolved all faculty and staff conflicts of interest regarding this educational activity.

Reprints: Sami T. Azar, MD, FACP, Department of Internal Medicine, Division of Endocrinology, American University of Beirut-Medical Center, 3 Dag Hammarskjold Plaza-8th Floor, New York, NY 10017-2324. E-mail: sazar@aub.edu.lb.

Chief Editor's Note: This article is the 4th of 18 that will be published in 2009 for which a total of up to 18 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2009 Lippincott Williams & Wilkins, Inc.