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• W2051237992 abstract "El cortisol es una hormona pluripotente, vital en la adaptación del organismo frente al estrés. Es esencial en el mantenimiento del tono y de la permeabilidad vascular, y de la integridad endotelial. Por ello, una respuesta suprarrenal inadecuada en el contexto de una enfermedad crítica, trastorno conocido como insuficiencia suprarrenal relativa, se puede asociar a consecuencias clínicas relevantes. El diagnóstico de este trastorno funcional no es posible en función de criterios clínicos y se basa en la determinación de los valores plasmáticos de cortisol antes y tras la estimulación adrenal con corticotropina. Diversos estudios realizados en la población general demuestran que la insuficiencia suprarrenal relativa acentúa la hiporreactividad vascular en pacientes con shock séptico y aumenta su mortalidad. Sin embargo, hay datos contradictorios acerca de la utilidad de la administración de corticoides en estos pacientes. Algunos estudios recientes indican, asimismo, que la insuficiencia suprarrenal relativa es muy frecuente en pacientes con una cirrosis avanzada y shock séptico y en la hepatitis fulminante. El presente artículo aborda los principales aspectos de la fisiopatología, el diagnóstico y el tratamiento de esta entidad en pacientes con hepatopatía aguda y crónica. Cortisol is a pluripotent hormone that is vital in the host adaptation to stress. It is essential to maintain the normal vascular tone, endothelial integrity and vascular permeability. Consequently, the failure of an appropriate adrenal response in the setting of critical illness, alteration known as relative adrenal insufficiency, may have important clinical consequences. The diagnosis of this entity is not possible on clinical grounds and relies on the measurement of plasma cortisol levels prior and after adrenal stimulation with synthetic corticotrophin. Several studies performed in the general population have shown that relative adrenal insufficiency contributes to vascular hyporesponsiveness in septic shock and increases mortality. However, contradictory data exist regarding the effects of hydrocortisone administration in these patients. Moreover, recent studies indicate that relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock and in fulminant hepatic failure. This chapter summarizes the main aspects of the physiopathology, diagnosis and treatment of this entity in patients with acute or chronic liver disease." @default.
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• W2051237992 date "2008-11-01" @default.
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• W2051237992 title "Insuficiencia suprarrenal relativa en la insuficiencia hepática aguda y crónica" @default.
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• W2051237992 doi "https://doi.org/10.1157/13128301" @default.
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