Abstract
The evidence that severe acute pancreatitis can result in critical illness-related corticosteroid insufficiency following impaired adrenal secretion is accumulating. The study by Peng and coworkers in Critical Care certainly contributes to that idea, even though the question whether relative adrenal insufficiency should prompt for treatment by substitution doses of corticosteroids remains unresolved. The study is discussed in terms of the risk factors, circumstances and significance of impaired corticosteroid secretion by adrenals in severe acute pancreatitis.
Highlights
Even though the recent Corticosteroid Therapy of Septic Shock (CORTICUS) study [4] does not suggest either the presence of corticosteroid insufficiency (CIRCI) and a benefit of corticosteroid treatment in septic shock, the concept can still not be refuted in view of a number of other studies documenting the issues in more severe septic shock [2,5,6]
The question remains whether shock originating from pancreatitis would manifest differently than septic shock from other origins, and, whether shock originating from pancreatitis would benefit from corticosteroid treatment
Current practise recommendations can only be based on the literature on ‘general’ septic shock, and substitution doses of corticosteroids are still considered useful in the early treatment of the syndrome according to a recent metaanalysis [6], when associated with relatively low adrenocorticotropic hormone (ACTH)-induced cortisol responses [2] and in spite of the negative CORTICUS trial [4,5]
Summary
Even though the recent Corticosteroid Therapy of Septic Shock (CORTICUS) study [4] does not suggest either the presence of CIRCI (as defined above) and a benefit of corticosteroid treatment in (relatively mild) septic shock, the concept can still not be refuted in view of a number of other studies documenting the issues in more severe septic shock [2,5,6]. Current practise recommendations can only be based on the literature on ‘general’ septic shock, and substitution doses of corticosteroids are still considered useful in the early treatment of the syndrome according to a recent metaanalysis [6], when associated with relatively low ACTH-induced cortisol responses [2] and in spite of the negative CORTICUS trial [4,5].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
