Abstract
The importance of adrenal function to survival in critically ill patients has been established; however, identifying the best method to diagnose adrenal insufficiency has been problematic. Multiple methods of determining adrenal function have been developed, each with its advantages and disadvantages. Serum-free cortisol levels are probably the most accurate, although obtaining this result is technically demanding. Cohen and colleagues investigated the feasibility of measuring tissue cortisol levels in burn patients and whether tissue cortisol levels could be used as a surrogate for plasma-free cortisol levels.
Highlights
The importance of adrenal function to survival in critically ill patients has been established; identifying the best method to diagnose adrenal insufficiency has been problematic
The authors hypothesized that tissue cortisol levels are more relevant as this is what binds to cellular cortisol receptors and leads to cortisol-associated physiological changes seen
The authors concluded that obtaining tissue cortisol levels was feasible, but there was no correlation between tissue and plasma cortisol levels
Summary
The importance of adrenal function to survival in critically ill patients has been established; identifying the best method to diagnose adrenal insufficiency has been problematic. In the previous issue of Critical Care, Cohen and colleagues [1] conducted a feasibility study and examined 10 burn patients and 3 healthy volunteers to determine whether there were correlations between tissue cortisol levels and plasma-free cortisol levels. The authors hypothesized that tissue cortisol levels are more relevant as this is what binds to cellular cortisol receptors and leads to cortisol-associated physiological changes seen.
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