Skip to Main Content
Home Books The Anesthesia Guide

Chapter 212. Critical Illness–Related Corticosteroid Insufficiency (CIRCI)

Nirav Mistry, MD; Adel Bassily-Marcus, MD, FCCP, FCCM

  • Sections
  • Print
  • Get Citation

    Citation

    AMA Citation
    Mistry N, Bassily-Marcus A. Mistry N, Bassily-Marcus A Mistry, Nirav, and Adel Bassily-Marcus.Chapter 212. Critical Illness–Related Corticosteroid Insufficiency (CIRCI). In: Atchabahian A, Gupta R. Atchabahian A, Gupta R Eds. Arthur Atchabahian, and Ruchir Gupta.eds. The Anesthesia Guide New York, NY: McGraw-Hill; 2013. http://accessanesthesiology.mhmedical.com/content.aspx?bookid=572&sectionid=42543805. Accessed October 17, 2018.
    MLA Citation
    Mistry N, Bassily-Marcus A. Mistry N, Bassily-Marcus A Mistry, Nirav, and Adel Bassily-Marcus.. "Chapter 212. Critical Illness–Related Corticosteroid Insufficiency (CIRCI)." The Anesthesia Guide Atchabahian A, Gupta R. Atchabahian A, Gupta R Eds. Arthur Atchabahian, and Ruchir Gupta. New York, NY: McGraw-Hill, 2013, http://accessanesthesiology.mhmedical.com/content.aspx?bookid=572&sectionid=42543805.

    Download citation file:

    RIS (Zotero)
    EndNote
    BibTex
    Medlars
    ProCite
    RefWorks
    Reference Manager
    Mendeley
    © Copyright
  • Tools
  • Search Book
  • Clip
Top

  • Critical illness–related corticosteroid insufficiency (CIRCI) is defined as inadequate corticosteroid activity for the severity of the patient's illness

  • Possible complications from corticosteroid therapy:
    • Immune suppression
    • Increased risk of infections (wound, nosocomial)
    • Impaired wound healing
    • Hyperglycemia
    • Myopathy
    • Psychosis
    • Hypokalemic metabolic acidosis
    • Further HPA and glucocorticoid receptor suppression

Table 212-1 Etiology, Symptoms, and Diagnosis of Adrenal Insufficiency in Critically Ill Patients
View Table|Favorite Table|Download (.pdf)
Table 212-1 Etiology, Symptoms, and Diagnosis of Adrenal Insufficiency in Critically Ill Patients
  • Etiology
    • Structural damage to adrenals
    • Drugs
    • Primary and secondary etiologies
    • Reversible hypothalamic–pituitary–adrenal dysfunction
  • Clinical manifestations
    • Primarily results in shock refractory to fluids and vasopressors
    • Consider in patients with progressive ALI/ARDS
    • Possible eosinophilia and hypoglycemia
    • Uncommonly—hyponatremia and hyperkalemia
  • Diagnosis
    • ACTH stimulation test no longer recommended
    • Random cortisol level <10 μg/dL
    • Alternative: cosyntropin stimulation test
      • Check cortisol level before 250 μg cosyntropin administration and then 30 and 60 min after
      • Diagnostic if change in cortisol is <9 μg/dL (difference between pre- and post-cosyntropin administration)
Figure 212-1. Algorithm for the Management of Patient with Suspected Critical Illness–Related Corticosteroid Insufficiency (CIRCI)
Image not available.
View Full Size|Favorite Figure|Download Slide (.ppt)
Image not available.
+
+
1. Marik P. Critical illness-related corticosteroid insufficiency. Chest. 2009 Jan;135(1):181–193.   [PubMed: 19136406]
+
+
2. Marik PE, Pastores SM, Ananne D, et al. 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. Crit Care Med. 2008 Jun;36(6):1937–1949.   [PubMed: 18496365]
+
+
3. Dellinger P, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for the management of severe sepsis and septic shock: 2008. Crit Care Med. 2008 Jan;36:296–327.   [PubMed: 18158437]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close