BACKGROUND AND OBJECTIVES: @entity288 were introduced in the treatment of severe @entity281 as early as in the nineteen forties. Several " negative" randomized controlled trials of high-dose of glucocorticoids given for a short period of time in the early course of severe @entity295 or @entity649 raised serious doubts on the benefit of this treatment. Recently, a link between @entity326 and @entity1887 , or systemic @entity32 induced glucocorticoids receptor resistance had been established. This finding prompted renewed interest of a replacement therapy with low doses of @entity288 during longer periods. The goal of this article is to review the key role of @entity288 in the host response to stress and will update the reader with the new validated indications of @entity288 treatment in the ICU. CONTENTS: Extensive review of the adrenal physiology and its pathophysiological derangements and clinical implications in @entity3124 @entity1 . CONCLUSIONS: During @entity295 , @entity1344 and perpetuation of inflammatory state may result from @entity1887 ( @entity1887 ). Thus, an ACTH test should be performed as soon as possible to identify non overt @entity1887 . It should be immediately followed by a replacement therapy with iv bolus of 50 mg of @entity701 every 6 hours combined to 50   g of @entity7842 once daily. When the results of the ACTH test are available, treatment should be continued for 7 days in the non responders to ACTH and withdraw in the responders. Whether responders to ACTH with high baseline @entity701 levels (> 34   g/dL) have tissue resistance to @entity701 and also should receive exogenous hormones remains to be evaluated in clinical trials.

@entity1887 in XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity326 :: ('MESH:D012772', 'Disease') :: ['septic shock'] @entity649 :: ('MESH:D012128', 'Disease') :: ['acute respiratory distress syndrome'] @entity1887 :: ('MESH:D000309', 'Disease') :: ['adrenal insufficiency', 'AI'] @entity3124 :: ('MESH:D016638', 'Disease') :: ['critically ill'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity701 :: ('MESH:D006854', 'Chemical') :: ['hydrocortisone', 'cortisol'] @entity1344 :: ('MESH:D043171', 'Disease') :: ['hemodynamic instability'] @entity7842 :: ('MESH:D005438', 'Chemical') :: ['fludrocortisone'] @entity288 :: ('MESH:D000305', 'Chemical') :: ['corticosteroids', 'Corticosteroids']
@entity295 :: (MESH:D018805,Disease) :: ['sepsis']
