Is there a role for dehydroepiandrosterone replacement in the intensive care population?

Dhatariya, Ketan

doi:10.1007/s00134-003-1981-y

Cited by 15 publications

(12 citation statements)

References 27 publications

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“…The natural concentration of DHEA(S) in the circulation is known to reach a peak after puberty and gradually decreases thereafter. Recently there have been several reports recommending the use of DHEA in the treatment of a wide range of disorders and diseases, including cancer, aging, depression, diabetes, obesity, atherosclerosis, memory loss, sarcopenia, and viral infection [13][14][15][16]. There has also been increasing interest in the therapeutic use of DHEA for the treatment of patients following severe burn, sepsis, or other major trauma [16 -18].…”

Section: Introductionmentioning

confidence: 99%

Effects of Dehydroepiandrosterone Administration on Rat Hepatic Metabolism Following Thermal Injury

Banta

Yokoyama

Berthiaume

et al. 2005

Journal of Surgical Research

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Section: Introductionmentioning

confidence: 99%

Effects of Dehydroepiandrosterone Administration on Rat Hepatic Metabolism Following Thermal Injury

Banta

Yokoyama

Berthiaume

et al. 2005

Journal of Surgical Research

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“…10 It remains to be elucidated whether DHEA administration may be beneficial to critically ill patients. 11 Measurements of DHEA levels, the bioactive component of adrenal androgens, have been presented in only a limited number of reports in critically ill septic patients and the results are controversial. 12,13 Furthermore, DHEA/DHEAS system alterations, following major surgery, are variable.…”

Section: Introductionmentioning

confidence: 99%

Pituitary-adrenal responses following major abdominal surgery

Dimopoulou¹,

Tzanela²,

Vassiliadi³

et al. 2008

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OBjeCTive: Perioperative pituitary-adrenal responses after major abdominal surgery have not been well characterized. The aim of the present study was to further clarify perioperative pituitary-adrenal responses. DeSiGN: Thirty-six patients (20 men), aged 68±10 years (mean±SD), undergoing major abdominal operations were studied. Total cortisol (TC), Adrenocorticotropic Hormone (ACTH), corticosteroid-binding globulin (CBG), dehydroepiandrosterone (DHeA) and its sulphate (DHeAS) were measured preoperatively (PreOp), on the day of surgery (DoS) and on the first and second postoperative days (PoD1 and PoD2). The free cortisol index (FCi) was also calculated. in addition, patients underwent a low-dose (1 μg) ACTH stimulation test, preoperatively and on PoD1, to assess adrenal responsiveness to ACTH. ReSulTS: TC, FCi, ACTH and DHeA were increased, while DHeAS and CBG declined on DoS compared to PreOp levels. On PoD1, plasma ACTH was lower compared to the preoperative levels, FCi remained elevated, DHeA, DHeAS and TC returned to their baseline values, while CBG was still low. On PoD2, ACTH and CBG were low and FCi returned to its PreOp levels. Postoperatively, stimulated FCi was higher compared to the PreOp value. CONCluSiON: At an early phase following major surgery, elevated cortisol is associated with high ACTH. Despite HPA activation and a concomitant rise in DHeA levels, DHeAS declines. later on, a remarkable dissociation between ACTH (low) and cortisol (high) is observed, which is attributed, at least in part, to increased adrenal responsiveness to ACTH.

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“…Furthermore, DHEA administration has beneficial effects on experimentalinduced sepsis in rodents (15)(16)(17)(18)(19)(20)(21). On this basis, DHEA deficiency in septic shock in man may warrant DHEA replacement therapy (12,22,23).…”

mentioning

confidence: 99%

Dissociation of Serum Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate in Septic Shock

Arlt¹,

Hammer²,

Sanning

et al. 2006

The Journal of Clinical Endocrinology & Metabolism

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Context: Dehydroepiandrosterone (DHEA) replacement in sepsis has been advocated because of the sepsis-associated decrease in serum DHEA sulfate (DHEAS). However, experimental sepsis in rodents leads to down-regulation of DHEA sulfotransferase, which inactivates DHEA to DHEAS, theoretically resulting in higher DHEA levels.Objective: The objective of the study was to test whether serum DHEA and DHEAS are dissociated in septic shock and to determine their association with circulating cortisol in the context of severity of disease and mortality.Design, Setting, and Participants: This was a cross-sectional study consisting of 181 patients with septic shock, 31 patients with acute trauma, and 60 healthy controls.Main Outcome Measures: Serum cortisol, DHEA, and DHEAS were measured before and 60 min after ACTH stimulation.Results: Serum cortisol was increased and DHEAS was decreased in both septic shock and trauma patients (all P Ͻ 0.001). However, compared with healthy controls, DHEA was significantly increased in sepsis but decreased after trauma (all P Ͻ 0.001). In sepsis, neither cortisol nor DHEA increased significantly after ACTH. Most severely ill patients had higher cortisol (P ϭ 0.069) and lower DHEA (P ϭ 0.076) and a significantly higher cortisol to DHEA ratio (P ϭ 0.004). Similarly, the cortisol to DHEA ratio was significantly increased in nonsurvivors of septic shock (P ϭ 0.026), whereas survivors did not differ from controls (P ϭ 0.322). Conclusions:The observed dissociation of DHEA and DHEAS in septic shock contradicts the previous concept of sepsis-associated DHEA deficiency. Increased DHEA levels may maintain the balance between glucocorticoid-and DHEA-mediated immune and vascular effects. However, most severe disease and mortality is associated with an increased cortisol to DHEA ratio, which may represent a novel prognostic marker in septic shock.

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Is there a role for dehydroepiandrosterone replacement in the intensive care population?

Cited by 15 publications

References 27 publications

Effects of Dehydroepiandrosterone Administration on Rat Hepatic Metabolism Following Thermal Injury

Effects of Dehydroepiandrosterone Administration on Rat Hepatic Metabolism Following Thermal Injury

Pituitary-adrenal responses following major abdominal surgery

Dissociation of Serum Dehydroepiandrosterone and Dehydroepiandrosterone Sulfate in Septic Shock

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