Suppletie met corticosteroïden bij ernstig zieke patiënten

- In critically ill patients, the hypothalamic-pituitary-adrenal axis is usually activated, resulting in elevated plasma cortisol levels. This enables the human organism to cope with sepsis, trauma and other forms of stress.

- During critical illness, total adrenal insufficiency rarely occurs. On the other hand, septic shock can be accompanied by a relative deficit of cortisol. Causes of this relative adrenal insufficiency are a dysfunction of the hypothalamic-pituitary-adrenal axis and/or cortisol resistance.

- There are no strict biochemical criteria available to diagnose relative adrenal insufficiency; clinical observation is the decisive factor.

- In randomised trials with patients in septic shock, a more rapid haemodynamic recovery was obtained with physiological doses of hydrocortisone than with a placebo.

- The observed haemodynamic response following hydrocortisone administration supports the concept of relative adrenal insufficiency.