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)

Djillali Annane, Stephen Pastores, Wiebke Arlt, Robert Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul Marik, Gianfranco Umberto Meduri, Keith Olsen, Bram Rochwerg, Sophia Rodgers, James Russell, Greet Van den Berghe

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)
370 Downloads (Pure)

Abstract

OBJECTIVE: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). PARTICIPANTS: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM).
DATA SOURCES: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews.
RESULTS: Three major pathophysiologic events were considered to constitute CIRCI: dysregulation of the hypothalamic pituitary adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex involving multidirectional crosstalk between the CRH-ACTH pathways, autonomic nervous system, vasopressinergic system, and the immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity.
CONCLUSIONS: Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.
Original languageEnglish
Pages (from-to)1781-1792
JournalIntensive Care Medicine
Volume43
Issue number12
Early online date21 Sep 2017
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Corticosteroid insufficiency
  • critical illness
  • sepsis
  • glucocorticoids
  • glucocorticoid receptor

Fingerprint

Dive into the research topics of '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)'. Together they form a unique fingerprint.

Cite this