ReviewNature reviews. Endocrinology2019
Adrenal function and dysfunction in critically ill patients.
Review in Nature reviews. Endocrinology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 80 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
80 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Association of inflammation and cognition in the elderly: A systematic review and meta-analysis.Frontiers in aging neuroscience · 2023Pooled it
- Cortisol Levels During Acute Illnesses in Children and Adolescents: A Systematic Review.JAMA network open · 2022Pooled it
- Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial.Liver international : official journal of the International Association for the Study of the Liver · 2025Trial
- Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function.Critical care (London, England) · 2024Trial
- The relationship between adrenocortical candidate gene expression and clinical response to hydrocortisone in patients with septic shock.Intensive care medicine · 2021Trial
- Use of corticosteroids in sepsis and infectious diseases: a narrative review.The Korean journal of internal medicine · 2026Review
- Endocrine Implications of Congenital Disorders of GlycosylationJournal of clinical research in pediatric endocrinology · 2026Review
- The metabolic response to stress in critical illness: updated review on the pathophysiological mechanisms, consequences, and therapeutic implications.Annals of intensive care · 2025Review
- Gamma-aminobutyric acid attenuates cortisol-induced damage in human colorectal adenocarcinoma cells via Nrf2 signaling.Die Naturwissenschaften · 2025Article
- Validation of an LC-MS/MS Method for Urinary Cortisol in Dogs and Reference Interval, with an Exploratory Comparison to Immunoassay.Animals : an open access journal from MDPI · 2025Article
- The ACTH test fails to diagnose adrenal insufficiency and augments cytokine production in sepsis.JCI insight · 2025Article
- Endocrine Disorders in Children with Primary Mitochondrial Diseases: Single Center ExperienceJournal of clinical research in pediatric endocrinology · 2025Article
- Perinatal glucocorticoid sensitivity in the preterm newborn: molecular mechanisms, endogenous determinants, and clinical implications.Frontiers in endocrinology · 2025Review
- Altered association between cortisol and adrenocorticotropic hormone levels in the early stage of type 2 diabetic ketoacidosis.Frontiers in endocrinology · 2025Article
- Identification of early predictors and model for bacterial infection in diabetic ketoacidosis patients: A retrospective study.PloS one · 2025Article
- Glucocorticoid therapy for sepsis in the AI era: a survey on current and future approaches.Computational and structural biotechnology journal · 2024Review
- Reversible central adrenal insufficiency in survivors of COVID-19: results from a 24-month longitudinal study.Endocrine connections · 2024Article
- Endogenous serum glucocorticoid concentrations, steroidogenic enzyme activity, and 90-day mortality in patients hospitalized with COVID-19: an observational cohort study.Endocrine connections · 2024Article
- Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines.Acute and critical care · 2024Article
- Adaptive Metabolic Responses Facilitate Blood-Brain Barrier Repair in Ischemic Stroke via BHB-Mediated Epigenetic Modification of ZO-1 Expression.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2024Article
20 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Critical illnesses are characterized by increased systemic cortisol availability, which is a vital part of the stress response. Relative adrenal failure (later termed critical-illness-related corticosteroid insufficiency (CIRCI)) is a condition in which the systemic availability of cortisol is assumed to be insufficiently high to face the stress of the illness and is most typically thought to occur in the acute phase of septic shock. Researchers suggested that CIRCI could be diagnosed by a suppressed incremental cortisol response to an injection of adrenocorticotropic hormone, irrespective of the baseline plasma cortisol. This concept triggered several randomized clinical trials on the impact of large stress doses of hydrocortisone to treat CIRCI, which gave conflicting results. Recent novel insights into the response of the hypothalamic-pituitary-adrenal axis to acute and prolonged critical illnesses challenge the concept of CIRCI, as currently defined, as well as the current practice guidelines for diagnosis and treatment. In this Review, these novel insights are integrated within a novel conceptual framework that can be used to re-appreciate adrenocortical function and dysfunction in the context of critical illness. This framework opens new avenues for further research and for preventive and/or therapeutic innovations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.