[Early changes in function of hypothalamic-pituitary-target gland axis in patients with severe sepsis and septic shock].
OBJECTIVE
To investigate the early changes in function of hypothalamic-pituitary-target gland (HPTG) axis in patients with severe sepsis and septic shock, in order to clarify its relationship with severity and prognosis of the patients.


METHODS
The serum contents of cortisol (F), triiodothyronine (T(3)), thyroxine (T(4)), thyrotropic-stimulating hormone (TSH), growth hormone (GH), follicle-stimulating hormone (FSH), luteotropic hormone (LH), prolactin (PRL) and plasma concentration of adrenocorticotrophic hormone (ACTH) in 10 severe sepsis and 12 septic shock patients on day 1, 3, 5 after diagnosis was made, and 12 patients with no infection or septic shock served as controls. The hypothalamic-pituitary adrenal gland axis (HPAA) function of the patients with severe sepsis and septic shock were evaluated with 1 microgram ACTH stimulation test given 1 day after the concentrations of the above hormones were determined.


RESULTS
Compared with the control patients, ACTH, T(3), T(4), GH, FSH, LH and PRL levels were significantly changed in patients with severe sepsis and septic shock (P<0.05 or P<0.01). The numbers of patients with reaction to 1 microgram ACTH stimulation test were similar between patients with severe sepsis (6 cases non-reaction and 3 cases reaction) and patients with septic shock (9 cases non reaction and 2 cases reaction, P>0.05). According to the acute physiology and chronic health evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) score, changes in ACTH, T(3), T(4), GH and PRL levels were closely related to the severity of illness (P<0.05 or P<0.01). Significant differences were found in ACTH, T(3), T(4) levels between survivors and non-survivors (P<0.05 or P<0.01). ACTH, T(4) levels and SOFA score were independent predictors of the 28-day hospital mortality (P<0.05 or P<0.01).


CONCLUSIONS
The early changes in HPTG axis are closely related with the severity and hospital mortality in patients with severe sepsis and septic shock.
Cui
Na
N
Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Liu
Da-wei
DW
Wang
Hao
H
Zeng
Zheng-pei
ZP
Long
Yun
Y
Chai
Wen-zhao
WZ
Liu
Hong-zhong
HZ
Wang
Xiao-ting
XT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011379:Prognosis; D018805:Sepsis / Q000097:blood / Q000503:physiopathology*; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology*; D055815:Young Adult
D006728:Hormones