The systemic adrenal stress response in severe sepsis and critical illness

Abstract

AbstractCurrent research indicates that the classic features of the stress response during sepsis and critical illness at the levels of the hypothalamic-pituitary-adrenal (HPA)-axis not only involve the glucocorticoid axis but also adrenocortical hormones such as mineralocorticoids and androgens like dehydroepiandrosterone-(sulfate). It became evident that these hormones act synergistically as part of a systemic endocrine stress response (SERS) during the systemic inflammatory response (SIRS) and the compensatory anti-inflammatory response (CARS). This article summarizes the basic principles of this interaction which provide the background for the dysfunction of the HPA-axis during critical illness. Furthermore, recent advances in clinical aspects such as diagnostics of relative adrenocortical insufficiency and substitution of hydrocortisone during septic shock are discussed.