title: The pituitary-gonadal-thyroid and lactotroph axes in critically ill patients.
abstract: BACKGROUND
  The normal circadian rhythm of hormones in critical patients becomes chaotic causing some hormones to increase and others to decrease abnormally. The goal of this study is to evaluate hormonal changes in severely ill patients and to investigate the relationship between hormonal changes and mortality and morbidity.
  
  
  METHODS
  We enrolled 20 patients (10 F/10 M). Blood samples were collected on day 0, day 5, and day 10. If a patient was discharged before these defined days, a sample was drawn on that day. Twenty healthy controls were included.
  
  
  RESULTS
  Female patients had lower LH, FSH, and fT₃ and higher PRL and cortisol levels than controls on admission to the intensive care unit (ICU) (pLH = 0.021, pFSH:0.001, pfT3 = 0.021, pPRL = 0.042, pCortisol <0.001, respectively). Men had significantly low testosterone and fT3, and high PRL and cortisol levels on ICU admission (pT = 0.01, pfT3 = 0.043, pPRL = 0.005, pCortisol < 0.001, respectively). The lowest levels of gonadotropins in both genders and testosterone in men were measured on day 5. Cortisol levels decreased in the patients discharged from the ICU (p = 0.01). FSH levels increased in recovered women (pFSH = 0.043). The mortality rate was 30%. There were correlations between admission TSH and NIMV duration (p = 0.006), fT3 and APACHE II (p = 0.001), and PRL and mortality (p = 0.044). Positive correlations between E2 and APACHE II (p = 0.003) in females, and PRL and APACHE II (p = 0.022) in males were also displayed.
  
  
  CONCLUSIONS
  Critically ill patients develop significant changes in neuroendocrine axes. Alterations in hormones correlate with the disease severity and mortality. (Endokrynol Pol 2016; 67 (3): 305-312).
authors.affiliation: Düzce University, School of Medicine, Department of Internal Medicine and Critical Care Unit, Düzce, Turkey. turkayakbas@yahoo.com.
authors.forename: Türkay
authors.initials: T
authors.lastname: Akbaş
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Deyneli
authors.forename: Firuze Turan
authors.initials: FT
authors.lastname: Sönmez
authors.forename: Sema
authors.initials: S
authors.lastname: Akalın
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006066:Gonads / Q000378:metabolism*; D006728:Hormones / Q000097:blood / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000378:metabolism*; D012737:Sex Factors; D013961:Thyroid Gland / Q000378:metabolism*
chemical_list: D006728:Hormones
keywords: mortality; neuroendocrine changes; prolactin; severe illness