ABSTRACT
En los últimos años se han producido avances en el conocimiento de los cambios que experimenta el eje suprarrenal durante las distintas fases de la enfermedad crítica. Dichos avances han cristalizado en un cambio de paradigma, de modo que las referidas adaptaciones ya no se consideran resultado de la activación del eje a nivel hipotalámico, como se ha considerado tradicionalmente, sino fruto de una disminución en el metabolismo periférico del cortisol. Estos nuevos datos obligan a reconsiderar el diagnóstico y tratamiento de la insuficiencia suprarrenal del enfermo crítico, una entidad hasta ahora escasamente comprendida (AU)
Recently, there have been advances in understanding of the changes that occur in the hypothalamic-pituitary-adrenal axis during the different stages of critical disease. Such advances have led to a paradigm change, so that the aforementioned adaptations are no longer considered the result of adrenal axis activation, but a consequence of decreased cortisol metabolism illness. Knowledge of this new pathophysiological bases should lead to reconsider the diagnosis and treatment of adrenal insufficiency in critically ill patients, a condition poorly understood to date (AU)
Subject(s)
Humans , Adrenal Insufficiency/etiology , Adrenal Insufficiency/pathology , Critical Care/methods , Hydrocortisone/metabolism , Adrenal Insufficiency/complications , Critical Illness/therapyABSTRACT
Recently, there have been advances in understanding of the changes that occur in the hypothalamic-pituitary-adrenal axis during the different stages of critical disease. Such advances have led to a paradigm change, so that the aforementioned adaptations are no longer considered the result of adrenal axis activation, but a consequence of decreased cortisol metabolism illness. Knowledge of this new pathophysiological bases should lead to reconsider the diagnosis and treatment of adrenal insufficiency in critically ill patients, a condition poorly understood to date.
