ABSTRACT
Adrenocortical hormones, which include the glucocorticoid cortisol (hydrocortisone) and
the mineralocorticoid (aldosterone), have a wide range of life-sustaining effects that
include the regulation of carbohydrate, protein, lipid, and nucleic acid metabolism, modu-
lation of immune responses, and control of body water, sodium, and potassium distribution
and excretion. During physiologic stress, glucocorticoids help maintain hemodynamic stab-
ility by enhancing the response of cardiac and vascular smooth muscle to catecholamines
and angiotensin II (1-5). Glucocorticoid deficiency can thus aggravate or precipitate critical
illness. Some degree of adrenal insufficiency (AI) is present in as many as 30% of critically
ill patients (6).
