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


METHODS
Prospective study in consecutive critically ill patients in a general intensive care unit in a teaching hospital.


METHODS
The study included 37 critically ill, mechanically ventilated patients with diverse underlying diagnoses (28 men, 9 women; median age 56 years).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Dimopoulou
Ioanna
I
Pesmazoglou 2 Street, 14561, Kifissia, Athens, Greece. idimo@otenet.gr
Alevizopoulou
Panagiota
P
Dafni
Urania
U
Orfanos
Stylianos
S
Livaditi
Olga
O
Tzanela
Marinella
M
Kotanidou
Anastasia
A
Souvatzoglou
Emmanouil
E
Kopterides
Petros
P
Mavrou
Irini
I
Thalassinos
Nikolaos
N
Roussos
Charis
C
Armaganidis
Apostolos
A
Tsagarakis
Stylianos
S
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000187:drug effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003346:Corticotropin-Releasing Hormone; D016638:Critical Illness; D016207:Cytokines / Q000097:blood / Q000187:drug effects; D005260:Female; D006728:Hormones; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests; D011446:Prospective Studies; D016019:Survival Analysis
D016207:Cytokines; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone