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Endocrine - Adrenal Insufficiency

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Hydrocortisone plus Fludrocortisone for Adults with Septic Shock.
Annane D, Renault A, Brun-Buisson C, Megarbane B, Quenot JP, Siami S, Cariou A, Forceville X, Schwebel C, Martin C, Timsit JF, Misset B, Ali Benali M, Colin G, Souweine B, Asehnoune K, Mercier E, Chimot L, Charpentier C, François B, Boulain T, Petitpas F, Constantin JM, Dhonneur G, Baudin F, Combes A, Bohé J, Loriferne JF, Amathieu R, Cook F, Slama M, Leroy O, Capellier G, Dargent A, Hissem T, Maxime V, Bellissant E; CRICS-TRIGGERSEP Network.
N Engl J Med. 2018 Mar 1;378(9):809-818.

Rationale for inclusion: This trial studying patients with septic shock found that the addition of fludrocortisone to hydrocortisone resulted in reduced 90-day all cause mortality as well as decreased vasopressor-free days and reduced organ failure compared to placebo control.

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Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM).
Annane D, Pastores SM, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS, Marik PE, Meduri GU, Olsen KM, Rochwerg B, Rodgers SC, Russell JA, Van den Berghe G.
Intensive Care Med. 2017 Dec;43(12):1781-1792.

Rationale for inclusion: This serves as a comprehensive review of CIRCI, including the pathophysiology and limitations of diagnostic tools for the identification of corticosteroid insufficiency in critical illness, supported by the two largest critical care societies. 

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Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017.
Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, Briegel J, Carcillo J, Christ-Crain M, Cooper MS, Marik PE, Umberto Meduri G, Olsen KM, Rodgers S, Russell JA, Van den Berghe G.
Intensive Care Med. 2017 Dec;43(12):1751-1763.

Rationale for inclusion: A multispecialty task force presents evidence-based recommendations regarding the diagnosis and treatment of CIRCI, including the use of glucocorticoids in sepsis, trauma, and ARDS.  Although relatively few citations, these recent recommendations update the 2008 guidelines. 

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A prospective multicenter study of adrenal function in critically ill children.
Menon K, Ward RE, Lawson ML, Gaboury I, Hutchison JS, Hébert PC; Canadian Critical Care Trials Group.
Am J Respir Crit Care Med. 2010 Jul 15;182(2):246-51.

Rationale for inclusion: PEDIATRICS: Prospective observational study - prevalence 30.2% in peds ICU patients

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Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study.
Hildreth AN, Mejia VA, Maxwell RA, Smith PW, Dart BW, Barker DE.
J Trauma. 2008 Sep;65(3):573-9.

Rationale for inclusion: Single dose Etomidate associated with adrenal inhibition, ICU stay, and vent days in trauma patients.

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Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine.
Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M; American College of Critical Care Medicine.
Crit Care Med. 2008 Jun;36(6):1937-49.

Rationale for inclusion: A concensus statement on the diagnosis and management of adrenal insufficiency.

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Duration of adrenal inhibition following a single dose of etomidate in critically ill patients.
Vinclair M, Broux C, Faure P, Brun J, Genty C, Jacquot C, Chabre O, Payen JF.
Intensive Care Med. 2008 Apr;34(4):714-9.

Rationale for inclusion: Single dose Etomidate associated with adrenal inhibition for 48 hours.

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Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?
de Jong MF, Beishuizen A, Spijkstra JJ, Girbes AR, Groeneveld AB.
Clin Endocrinol (Oxf). 2007 May;66(5):732-9. Epub 2007 Mar 23.

Rationale for inclusion: Steroid treatment did not change outcome in relative adrenal insufficiency in nonseptic ICU patients.

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Adrenal function in sepsis: the retrospective Corticus cohort study.
Lipiner-Friedman D, Sprung CL, Laterre PF, Weiss Y, Goodman SV, Vogeser M, Briegel J, Keh D, Singer M, Moreno R, Bellissant E, Annane D; Corticus Study Group.
Crit Care Med. 2007 Apr;35(4):1012-8.

Rationale for inclusion: The classic CORTICUS Study: baseline cortisol less than 15 or deltamax <9 had higher likelihood of dying.

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A single adrenocorticotropic hormone stimulation test does not reveal adrenal insufficiency in septic shock.
Loisa P, Uusaro A, Ruokonen E.
Anesth Analg. 2005 Dec;101(6):1792-8.

Rationale for inclusion: Results of ACTH stim test are not reproducible in patients with septic shock

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Adrenal insufficiency during septic shock.
Marik PE, Zaloga GP.
Crit Care Med. 2003 Jan;31(1):141-5.

Rationale for inclusion: Cortisol < 25 for diagnosis of adrenal insufficiency in septic shock.

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Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma.
Beishuizen A, Thijs LG, Vermes I.
Intensive Care Med. 2001 Oct;27(10):1584-91.

Rationale for inclusion: Decrease then normalization of binding globulin in sepsis and multitrauma patients.

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