Pituitary-adrenal responses to human corticotropin-releasing hormone in critically ill patients

• Published in: Intensive care medicine 2007-03, Vol.33 (3), p.454-459
• Main Authors: DIMOPOULOU, Ioanna, ALEVIZOPOULOU, Panagiota, THALASSINOS, Nikolaos, ROUSSOS, Charis, ARMAGANIDIS, Apostolos, TSAGARAKIS, Stylianos, DAFNI, Urania, ORFANOS, Stylianos, LIVADITI, Olga, TZANELA, Marinella, KOTANIDOU, Anastasia, SOUVATZOGLOU, Emmanouil, KOPTERIDES, Petros, MAVROU, Irini
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenocorticotropic Hormone - blood; Adrenocorticotropic Hormone - drug effects; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Corticotropin-Releasing Hormone; Critical Illness; Cytokines - blood; Cytokines - drug effects; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; Hormones; Humans; Hydrocortisone - blood; Intensive care medicine; Logistic Models; Male; Medical sciences; Middle Aged; Pituitary-Adrenal Function Tests; Prospective Studies; Survival Analysis
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-006-0491-0

To investigate the pattern of pituitary-adrenal responses to human corticotropin-releasing hormone (hCRH) in critically ill patients and to examine the relation between responses and clinical outcome. Prospective study in consecutive critically ill patients in a general intensive care unit in a teaching hospital. The study included 37 critically ill, mechanically ventilated patients with diverse underlying diagnoses (28 men, 9 women; median age 56 years). A morning blood sample was obtained to measure baseline cortisol, corticotropin (ACTH), and cytokines. Patients were then injected with 100 microg hCRH, and plasma cortisol and ACTH were measured over a period of 2 h. In the overall patient population baseline and peak cortisol concentrations following hCRH were 16+/-5 and 21+/-5 microg/dl, respectively, and median baseline and peak ACTH levels 23 and 65 pg/ml, respectively. Higher ACTH levels and longer release of cortisol were noted in nonsurvivors (n=18) than in survivors (n=19). Furthermore, nonsurvivors had higher concentrations of interleukin 8 (115 vs. 38 pg/ml) and interleukin 6 (200 vs. 128 pg/ml) than survivors. Critically ill patients demonstrate altered pituitary-adrenal axis responses to hCRH. This is particularly evident in the sickest patients with the highest degree of inflammatory profile who ultimately do not survive.