Question 1

What is the Meaning of Relative Adrenal Insufficiency?

Accepted Answer

Relative adrenal insufficiency describes a state where adrenal cortisol production is insufficient to meet the body's significantly increased demand during severe physiological stress. Baseline cortisol levels may appear normal, yet the adrenal response is inadequate for the acute, elevated need. This represents a functional deficit, not complete gland failure.

Question 2

What is the Context of Relative Adrenal Insufficiency?

Accepted Answer

This condition operates within the hypothalamic-pituitary-adrenal (HPA) axis, the neuroendocrine system governing stress response. During critical illness, glucocorticoid demand escalates dramatically. Relative adrenal insufficiency occurs when adrenals cannot adequately increase cortisol secretion to counteract systemic inflammation and hemodynamic instability associated with severe stressors.

Question 3

What is the Significance of Relative Adrenal Insufficiency?

Accepted Answer

Clinically, recognizing relative adrenal insufficiency is crucial for managing critically ill patients. Unaddressed, it contributes to persistent hypotension refractory to vasopressors, prolonged organ dysfunction, and elevated mortality risk. Prompt identification and appropriate intervention can stabilize hemodynamics, mitigate systemic inflammation, and improve patient prognosis in intensive care.

Question 4

What is the Mechanism of Relative Adrenal Insufficiency?

Accepted Answer

The mechanism involves complex factors impairing adrenal capacity to augment cortisol production under extreme stress. This includes cytokine-mediated suppression of steroidogenesis, reduced adrenal blood flow, or impaired tissue sensitivity. Despite elevated ACTH, the adrenal cortex fails to proportionally increase glucocorticoid output, leading to a functional deficit.

Question 5

What is the Application of Relative Adrenal Insufficiency?

Accepted Answer

In clinical practice, relative adrenal insufficiency is considered in patients experiencing shock unresponsive to conventional fluid resuscitation and vasopressor therapy. Low-dose corticosteroids, typically hydrocortisone, serve as a supportive therapeutic strategy. This aims to supplement inadequate endogenous cortisol supply during acute stress, helping restore vascular tone, reduce inflammation, and support physiological stability.

Question 6

What is the Metric of Relative Adrenal Insufficiency?

Accepted Answer

Assessing relative adrenal insufficiency often involves evaluating cortisol levels, though no single test is universally definitive in critical care. Basal serum cortisol provides initial indication. A more comprehensive assessment may include the ACTH stimulation test, measuring cortisol response to synthetic ACTH. Clinical improvement following corticosteroid therapy also serves as a practical metric.

Question 7

What is the Risk of Relative Adrenal Insufficiency?

Accepted Answer

The primary risk of unmanaged relative adrenal insufficiency is progression to refractory shock, multi-organ failure, and fatal outcomes in critically ill individuals. Conversely, administering corticosteroids without clear indication or at excessive doses carries risks including hyperglycemia, increased infection susceptibility, fluid retention, and electrolyte disturbances. Careful patient selection, precise dosing, and vigilant monitoring are essential.

Relative Adrenal Insufficiency

Meaning

Context

Significance

Mechanism

Application

Metric

Risk

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