Marik Paul E, Zaloga Gary P
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Chest. 2002 Nov;122(5):1784-96. doi: 10.1378/chest.122.5.1784.
Stress from many sources, including pain, fever, and hypotension, activates the hypothalamic-pituitary-adrenal (HPA) axis with the sustained secretion of corticotropin and cortisol. Increased glucocorticoid action is an essential component of the stress response, and even minor degrees of adrenal insufficiency can be fatal in the stressed host. HPA dysfunction is a common and underdiagnosed disorder in the critically ill. We review the risk factors, pathophysiology, diagnostic approach, and management of HPA dysfunction in the critically ill.
来自多种来源的应激，包括疼痛、发热和低血压，会激活下丘脑-垂体-肾上腺（HPA）轴，导致促肾上腺皮质激素和皮质醇持续分泌。糖皮质激素作用增强是应激反应的一个重要组成部分，即使是轻微程度的肾上腺功能不全在应激宿主中也可能是致命的。HPA功能障碍在危重症患者中是一种常见但诊断不足的疾病。我们综述了危重症患者HPA功能障碍的危险因素、病理生理学、诊断方法和管理。
