_insufficiency in critically ill patients 危重病人肾上腺皮质功能不全课件

ADRENAL INSUFFICIENCY IN CRITICALLY ILL PATIENTS Dalal Abdelgadir R2 pediatics Objectives To review normal physiology of adrenal gland and glucocorticoids Normal adrenal response to stress Adrenal insufficiency in critical illness: pathophysiology and incidence Evidence of treatment with glucocorticoids Case presentation Recommendation for diagnosis and management in adult patients Physiology of the adrenal gland CRH produced by hypothalamus CRH stimulates pituitary gland to produce ACTH ACTH stimulates adrenals to produce cortisol Cortisol exerts a negative feedback on production of CRH and Cortisol Zona fasiculata 75% Zona Glomerulosa 15% Zona reticularis 10% mineralocorticoids Stress cortisol, androgens Basal cortisol, androgens Production of steroid hormones Physiology of glucocorticoids 90% bound to corticosteroid binding globulin and albumin to a lesser extent 10% free cortisol is physiologically active, half life is 70 -120 mins Cortisol is not stored in adrenal gland Glucocorticoids bind to intracelullar receptors then moves into the nucleus affecting transcription of various genes Physiology of glucocorticoids Metabolic: Stimulates gluconeogenesis, decrease glucose utilization Decreases protein synthesis and increases catabolism Increases lypolysis and oxidation of fatty acids Cardiovascular: Increases blood pressure Increases sensitivity of vasculature to catecholamines Margaret