Abstract
Endocrine dysfunction is common in severe sepsis and is associated with increased
morbidity and mortality risk. Clinical detection of this heterogenous disorder is
limited, and the accuracy of laboratory diagnosis is complicated by the limitations
in hormonal assays and the variable definitions used in its diagnosis. This article
reviews the common hormone therapies that have been evaluated in the critically ill
patient with sepsis, namely corticosteroids, vasopressin and insulin. There are numerous
adult clinical trials in this area, some of which have revealed conflicting results.
Pediatric data is much more limited. We present current recommendations for hormone
therapy in adults and children, but caution that further study is needed to better
understand the dynamic and complex endocrine responses during septic shock, and to
develop improved methods for diagnosis and monitoring of patient response, so that
we can determine not only which therapies to use, but how, in what combinations, and
in which patients.
Keywords
Hormone - corticosteroids - vasopressin - insulin - sepsis
