Glucocorticoid receptors in critically ill patients

In critically ill patients, the hypothalamic-pituitary-adrenal axis is activated and as a consequence these patients exhibit increased serum cortisol concentrations. However, a number of patients have relatively low cortisol levels for the degree of illness severity. Glucocorticoid actions are facilitated by the glucocorticoid receptor whose dysfunction leads to glucocorticoid tissue resistance. Most clinical studies in critically ill adult patients have studied cortisol availability, and only a few have investigated glucocorticoid receptor levels and function. In this review we will explore the conflicting results that have arisen from the clinical studies that aimed to elucidate the role of glucocorticoid receptor in glucocorticoid resistance. The study of receptor function and expression might aid in identifying the patients who will benefit from corticosteroid administration.