Hormones in the critically ill patient: to intervene or not to intervene?

Ligtenberg, J J M; Girbes, Armand R.J.; Beentjes, Jam; Tulleken, J. E.; Werf, Tjip S. van der; Jg, Zijlstra

doi:10.1007/s001340101050

Cited by 37 publications

(28 citation statements)

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“…We were not able to perform ACTH stimulation testing, nor were we able to confirm a laboratory diagnosis of adrenal dysfunction with a clinical response to a trial of corticosteroid therapy. The use of ACTH stimulation testing to diagnose adrenal dysfunction in critically ill patients is controversial (7,24,28). Because critical illness itself may result in maximal adrenal stimulation, such testing may reveal little about the sufficiency of the adrenal response (28).…”

Section: Discussionmentioning

confidence: 99%

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Magill

Puthanakit²,

Carson

et al. 2004

Antimicrob Agents Chemother

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Fluconazole is widely used in the intensive care unit for prevention and treatment of fungal infections. Case reports have described an association between fluconazole and adrenal dysfunction, an important cause of morbidity and mortality in critically ill patients. We sought to determine whether 400 mg of fluconazole per day administered to critically ill surgical patients was associated with a reduction in cortisol levels. Cortisol levels were measured in stored plasma specimens drawn from 154 critically ill surgical patients randomized in 1998-1999 to receive fluconazole or placebo for the prevention of candidiasis. The primary outcome measure was the median plasma cortisol level >1 day after study drug initiation (MPCL). Secondary outcomes were adrenal dysfunction, defined as an MPCL of <15 g/dl, changes in cortisol levels over time, and mortality. The median MPCL was 15.75 g/dl (interquartile range [IQR], 11.65 to 21.33 g/dl) in 79 patients randomized to fluconazole and 16.71 g/dl (IQR, 11.67 to 23.00 g/dl) in 75 patients randomized to placebo (P ‫؍‬ 0.52). Patients randomized to fluconazole did not have significantly increased odds of adrenal dysfunction compared to patients randomized to placebo (odds ratio, 0.98; 95% confidence interval, 0.48 to 2.01). Randomization to fluconazole was not associated with a significant difference in cortisol level changes over time. Mortality was not different between patients with and without adrenal dysfunction, nor was it different between patients with adrenal dysfunction who were randomized to fluconazole and those randomized to placebo. Fluconazole prophylaxis in this population of critically ill surgical patients did not result in significant adrenal dysfunction.

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Section: Discussionmentioning

confidence: 99%

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Magill

Puthanakit²,

Carson

et al. 2004

Antimicrob Agents Chemother

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“…Nine of our patients had cortisol concentrations lower than 150 nmol/l during the study; one of these patients died. Although low-dose corticosteroids appear to be useful in patients with catecholamine-dependent septic shock [28,29,30], there is no evidence that corticosteroid replacement therapy is beneficial in all intensive care patients [31]. This may be because the diagnosis of adrenal insufficiency in critical illness is difficult [31].…”

Section: Patients With Abnormally Low Endocrine Valuesmentioning

confidence: 94%

“…Although low-dose corticosteroids appear to be useful in patients with catecholamine-dependent septic shock [28,29,30], there is no evidence that corticosteroid replacement therapy is beneficial in all intensive care patients [31]. This may be because the diagnosis of adrenal insufficiency in critical illness is difficult [31]. Some workers have suggested the concept of a relative adrenal insufficiency [32,33,34] where cortisol concentration becomes elevated in response to critical illness but not to the level required for benefit to the patient.…”

Section: Patients With Abnormally Low Endocrine Valuesmentioning

confidence: 99%

Endocrine measurements in survivors and non-survivors from critical illness

et al. 2002

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“…Indeed, chronic diseases such as arthritis (Templ et al 1996, Lopez-Calderon et al 1999, parasitism (Elsasser et al 1988) and the chronic phase of critical illness (Ligtenberg et al 2001, Van Den Berghe 2002 are all associated with a decrease in one or more pituitary functions, including somatotropic functions, which results in a catabolic and wasting syndrome state.…”

Section: Figurementioning

confidence: 99%

Alterations of somatotropic function in prion disease in sheep

Viguié¹,

Chilliard²,

Gayrard³

et al. 2004

Journal of Endocrinology

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This study aimed at investigating the possible linkage between natural scrapie and alterations of the somatotropic axis. Scrapie-affected ewes exhibited 2-fold higher mean GH concentrations during both autumn and spring. GH pulse frequencies were higher in scrapie-affected ewes than in control animals (mean S.E.M. number of pulses/ 24 h: 10·4 0·9 and 7·6 0·9 for scrapie-affected and control ewes respectively) suggesting the involvement of central mechanisms. GH secretion induced by administration of an 2 -adrenergic agonist, which acts centrally to stimulate GH secretion, was similar between healthy and scrapie-affected ewes (ratios of the area under the curve (AUC) of GH concentration after to the GH AUC before the agonist administration were 3·6 1·6 and 4·9 1·0 for scrapie-affected and control ewes respectively). Finally, humoral markers and parameters of the metabolic status were determined to test the hypothesis that scrapieassociated alterations of GH secretion could be related to disruption of metabolic homeostasis. Glucose, insulin and urea plasma concentrations were higher in scrapie-affected than in healthy ewes. Neither leptin nor IGF-I levels were affected by scrapie. Total thyroxine (T4) was decreased in scrapie-affected ewes but free T4 and total and free tri-iodothyronine were not modified. In conclusion, our results showed the existence in scrapie-affected ewes of endocrine and metabolic alterations typical of acute illness proceeding, at least in part, from central mechanisms.

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Hormones in the critically ill patient: to intervene or not to intervene?

Cited by 37 publications

References 0 publications

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients

Endocrine measurements in survivors and non-survivors from critical illness

Alterations of somatotropic function in prion disease in sheep

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