Endocrinología crítica de las glándulas suprarrenales y el eje hipotálamo hipofisario adrenal: Artículo de revisión

The concept of relative adrenal insufficiency is currently predominant and is the paradigm that governs glucocorticoid treatment in critically ill patients. In this chapter, we propose a new criterion that allows a deeper revision at the cellular and molecular level and expands the criterion to a hypothalamic-pituitary-adrenal-cell axis under physiological-molecular foundations established in recent years The history of therapeutics is reviewed steroid until you get to the current indications. The lack of scientific evidence is recognized throughout the ages for full justification of its administration. In the absence of objective scientific evidence, the presence of relative adrenal insufficiency is discussed, which makes it possible to postulate the existence of peripheral adrenal insufficiency and/or resistance to cortisol. The therapeutic attitude supported in the new peripheral criterion of adrenal insufficiency is proposed and the need for further research on this unresolved issue is recognized. The final approach of this topic calls for a broader vision that goes beyond the hypothalamic-pituitary axis.