ICU SAQs · Endocrine & metabolic emergencies
The endocrine derangements of the septic patient
A CICM Second-Part SAQ on the critical-illness endocrine derangements — the stress hyperglycaemia (moderate control), the sick euthyroid (no replacement), the CIRCI (hydrocortisone for refractory shock).
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Prompt
A septic ICU patient day 5 has glucose 14 mmol/L, TSH 0.3 with normal T4, and is on high-dose noradrenaline. Outline the endocrine assessment and the management.
Question
A septic ICU patient day 5 has glucose 14 mmol/L, TSH 0.3 with normal T4, and is on high-dose noradrenaline. Outline the endocrine assessment and the management.
[5] [6]References5ShowHide
- [2]Mottale R, Dupuis C, Szklarzewska S, et al. The metabolic response to stress in critical illness: updated review. Annals of Intensive Care, 2025.PMID 41139771
- [3]Fowler C, Raoof N, Pastores SM Sepsis and Adrenal Insufficiency. Journal of Intensive Care Medicine, 2023.PMID 37365820
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [5]Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock JAMA, 2002.PMID 12186604
- [6]Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients N Engl J Med, 2009.PMID 19318384