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Category: Critical Care Medicine-Endocrine Disorders--->Hypothalamic-Pituitary-Adrenal Axis
Page: 2

Question 6#Print Question

A 48-year-old man with a history of asthma treated with intermittent steroids, and a history of kidney stones, is admitted to the ICU with urosepsis. He is intubated, started on antibiotics, and fluid resuscitated with 30 mL/kg of normal saline. Despite this therapy he becomes increasingly hypotensive requiring escalating vasopressor doses. An ACTH stimulation test is performed revealing a baseline cortisol of 10 µg/dL and a 30-minute peak of 16 µg/dL.

Which of the following interventions is most appropriate given the ACTH test results?

A. Administer corticosteroids, she is adrenally insufficient
B. A second test is needed to rule out daily variation
C. Do not administer corticosteroids, she has adequate adrenal function
D. Do not administer corticosteroids, the ACTH stimulation test is unreliable in sepsis


Question 7#Print Question

A 75-year-old man is admitted to the ICU with septic shock. Broad spectrum antibiotics are initiated, and he undergoes fluid resuscitation. Despite receiving 5 L of lactated ringers, he remains hypotensive requiring high-dose norepinephrine and vasopressin infusions. Cardiac ultrasound reveals hyperdynamic ventricular function without other abnormalities.

Which of the following statements regarding administration of systemic corticosteroids is most appropriate for this patient? 

A. Perform an ACTH stimulation test and give methylprednisolone if adrenally insufficient
B. Perform an ACTH stimulation test and give hydrocortisone if adrenally insufficient
C. Give hydrocortisone, there is no need for ACTH stimulation testing
D. Do not start corticosteroids in this patient


Question 8#Print Question

A 56-year-old woman with hypertension, rheumatoid arthritis, and gastroesophageal reflux disease is admitted to the ICU after undergoing a bowel resection for perforated diverticulitis. Her home medications include lisinopril 10 mg, prednisone 15 mg, and omeprazole 40 mg. She is treated with piperacillin-tazobactam and receives adequate fluid resuscitation over the next 24 hours but continues to require vasopressors for hypotension.

Given a concern for adrenal insufficiency, which of the following steroids is most appropriate to administer to this patient?

A. Prednisone
B. Dexamethasone
C. Fludrocortisone
D. Hydrocortisone




Category: Critical Care Medicine-Endocrine Disorders--->Hypothalamic-Pituitary-Adrenal Axis
Page: 2 of 2