The best known feature that suggests a possible underlying adrenal insufficiency is low blood pressure despite resuscitation with intravenous fluids, requiring vasopressor drugs. These patients typically display tachycardia and other signs of hyperdynamic shock. Other symptoms include fever, purpura fulminans, and gastrointestinal or neurological disturbances. All these features are relatively non-specific in intensive care patients.
In some patients a specific reason for adrenal insufficiency can be suspected, such as prior intake of corticosteroids that suppressed the HPA axis, or use of enzyme inducing drugs such as phenytoin. Treatment with imidazole drugs such as etomidate, ketoconazole and miconazole can also suppress the HPA axis, as well as drugs used specifically for this purpose, such as metyrapone.
Several blood test abnormalities can suggest corticosteroid insufficiency, such as hypoglycaemia, hyponatremia, hyperkalemia, hypercalcemia, neutropenia, eosinophilia, hyperprolactinemia and hypothyroidism.
Read more about this topic: Critical Illness-related Corticosteroid Insufficiency
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