title: Pituitary-adrenal responses to human corticotropin-releasing hormone in critically ill patients.
abstract: 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.
authors.affiliation: Pesmazoglou 2 Street, 14561, Kifissia, Athens, Greece. idimo@otenet.gr
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Panagiota
authors.initials: P
authors.lastname: Alevizopoulou
authors.forename: Urania
authors.initials: U
authors.lastname: Dafni
authors.forename: Stylianos
authors.initials: S
authors.lastname: Orfanos
authors.forename: Olga
authors.initials: O
authors.lastname: Livaditi
authors.forename: Marinella
authors.initials: M
authors.lastname: Tzanela
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotanidou
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Souvatzoglou
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Irini
authors.initials: I
authors.lastname: Mavrou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Thalassinos
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tsagarakis
mesh_terms: 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
chemical_list: D016207:Cytokines; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone