Enlarged adrenals during septic shock

Excerpt

Sir, the hypothalamic-pituitary adrenal axis is an essential part of the host response to infection. It is usually characterized by increased levels of plasma cortisol. Disruption of this endocrine axis may contribute to patients' worsening from uncomplicated sepsis to multiple organ dysfunction and death [1]. The underlying mechanisms are complex and may include direct damage to the endocrine tissues or interferences between pro-inflammatory mediators or drugs and hormonal metabolism. Subsequently, the hormonal pattern may vary from a syndrome of very low cortisol levels suggestive of impaired synthesis to a syndrome of high cortisol levels suggestive of impaired tissue uptake of cortisol. …