Hypothalamic-pituitary-adrenal insufficiency

Adrenal insufficiency is a common and underdiagnosed disorder in critically ill patients. Bacterial sepsis and infection with the human immune deficie ncy virus are the most common etiologies. Adrenal insufficiency results fro m acquired defects within the hypothalamus, pituitary, or adrenal glands. C ytokines and other peptides released during systemic inflammation impair th e function of the adrenal axis and are major causes of adrenal insufficienc y during critical illness. The most common clinical finding suggestive of a drenal insufficiency is hypotension. Treatment with glucocorticoids may imp rove the outcome of these patients.